A. Espinel-ingroff, In vitro fungicidal activities of voriconazole, itraconazole, and amphotericin B against opportunistic moniliaceous and dematiaceous fungi, J CLIN MICR, 39(3), 2001, pp. 954-958
The NCCLS proposed standard M38-P describes standard parameters for testing
the fungistatic antifungal activities (MICs) of established agents against
filamentous fungi (molds); however, standard conditions are not available
for testing their fungicidal activities (minimum fungicidal or lethal conce
ntrations [MFCs]). This study evaluated the in vitro fungistatic and fungic
idal activities of voriconazole, itraconazole, and amphotericin B against 2
60 common and emerging molds (174 Aspergillus sp. isolates [five species],
23 Fusarium sp. isolates [three species], 6 Paecilomyces lilacinus isolates
, 6 Rhizopus arrhizus isolates, 23 Scedasporium sp. isolates, 23 dematiaceo
us fungi, and 5 Trichoderma longibrachiatum isolates). MICs were determined
by following the NCCLS M38-P broth microdilution method. MFCs mere the low
est drug dilutions that resulted in fewer than three colonies. Voritonazole
showed similar or better fungicidal activity (MFC at which 90% of isolates
tested are killed [MFC90], 1 to 2 mug/ml) than the reference agents for As
pergillus spp. with the exception of Aspergillus terreus (MFC90 of voricona
zole and amphotericin B, >8 mug/ml). The voriconazole geometric mean (G mea
n) MFC for Scedosporium apiospermum was lower (2.52 mug/ml) than those of t
he other two agents (5.75 to 7.5 mug/ml). In contrast, amphotericin B and i
traconazole G mean MFCs for R. arrhizus were 2.1 to 2.2 mug/ml, but that fo
r voriconazole was >8 mug/ml. Little or no fungicidal activity was shown fo
r Fusarium spp. (2 to >8 mug/ml) and Scedosporium prolificans (>8 mug/ml) b
y the three agents, but voriconazole had some activity against P. lilacinus
and T. longibrachiatum (G mean MFCs, 1.8 and 4 mug/ml, respectively). The
fungicidal activity of the three agents was similar (G mean MFC, 1.83 to 2.
36 mug/ml) for the dematiaceous fungi with the exception of the azole MFCs
(>8 mug/ml) for some Bipolaris spicifera and Dactylaria constricta var. gal
lopava. These data extend and corroborate the available fungicidal results
for the three agents. The role of the MFC as a predictor of clinical outcom
e needs to be established in clinical trials by following standardized test
ing conditions for determination of these in vitro values.