Titre
Correlation between in vitro and in vivo activity of antifungal agents against yeasts
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Bille, J.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
1156-5233
Statut éditorial
Publié
Date de publication
1996
Volume
6
Numéro
3
Première page
118
Dernière page/numéro d’article
122
Peer-reviewed
Oui
Langue
anglais
Notes
Publication type : Article
Résumé
Antifungal susceptibility testing for yeasts ideally should allow to compare the activity of various antifungal agents, to monitor the development of resistance, to establish the potential activity of new compounds, and most importantly to predict the outcome of therapy. Today, the correlation between in vitro antifungal susceptibility testing and in vivo clinical results has been established only in a limited number of clinical settings.
Results vary according to: i) the causative agent (Candida albicans, other species of Candida, Cryptococcus neoformans);li)the type of antifungal agent (polyene, 5-fluorocytosine, azole compound); iii)the host (patients with AIDS, with other cause of immunodeficiency, immunocompetent patients); and iv) the type of infection, either superficial or deep seated.
A therapeutic failure due to an in vitro resistant yeast strain is still infrequent today, beside the context of HIV-infected or AIDS patients with iterative oropharyngeal candidosis. In this setting, numerous studies have now documented the good in vitro-in vivo correlation, particularly with azoles derivatives such as fluconazole.
At the opposite, one should note the lack in vitro-in vivo correlation in the following situations: i) chronic vulvo-vaginal candidosis due to C. albicans strains, which are uniformly susceptible to azoles; ii) episodes of candidemia caused by various species of Candida in non neutropenic patients treated either by amphotericin B or by fluconazole; iii) C. neoformans recurrent meningitis treated either by amphotericin B or by fluconazole.
Among the possible causes of a lack of in vitro-in vivo correlation, one could list: i) the insufficiant dispersion of the measured MIC values of Candida strains for amphotericin B; ii) hosts factors such as severe immunodepression, complex pathologies, the presence of colonized foreign bodies or i.v. catheters, problems of-compliance, or potential interactions with other drugs; iii) some factors inherent to the yeast, such as its variable pathogenicity, virulence, or propension to colonization; iv) some properties of the antifungal agent such as its biodisponibility or pharmacokinetics.
Today it seems important for the day to day management of fungal infections to restrict the in vitro susceptibility testing of antifungal drugs for yeasts to those few situations where a good in vitro-in vivo correlation has been established.
Results vary according to: i) the causative agent (Candida albicans, other species of Candida, Cryptococcus neoformans);li)the type of antifungal agent (polyene, 5-fluorocytosine, azole compound); iii)the host (patients with AIDS, with other cause of immunodeficiency, immunocompetent patients); and iv) the type of infection, either superficial or deep seated.
A therapeutic failure due to an in vitro resistant yeast strain is still infrequent today, beside the context of HIV-infected or AIDS patients with iterative oropharyngeal candidosis. In this setting, numerous studies have now documented the good in vitro-in vivo correlation, particularly with azoles derivatives such as fluconazole.
At the opposite, one should note the lack in vitro-in vivo correlation in the following situations: i) chronic vulvo-vaginal candidosis due to C. albicans strains, which are uniformly susceptible to azoles; ii) episodes of candidemia caused by various species of Candida in non neutropenic patients treated either by amphotericin B or by fluconazole; iii) C. neoformans recurrent meningitis treated either by amphotericin B or by fluconazole.
Among the possible causes of a lack of in vitro-in vivo correlation, one could list: i) the insufficiant dispersion of the measured MIC values of Candida strains for amphotericin B; ii) hosts factors such as severe immunodepression, complex pathologies, the presence of colonized foreign bodies or i.v. catheters, problems of-compliance, or potential interactions with other drugs; iii) some factors inherent to the yeast, such as its variable pathogenicity, virulence, or propension to colonization; iv) some properties of the antifungal agent such as its biodisponibility or pharmacokinetics.
Today it seems important for the day to day management of fungal infections to restrict the in vitro susceptibility testing of antifungal drugs for yeasts to those few situations where a good in vitro-in vivo correlation has been established.
PID Serval
serval:BIB_FA5A25F90DE4
Date de création
2008-02-11T11:39:59.661Z
Date de création dans IRIS
2025-05-21T05:29:26Z