Atividade in vitro da terbinafina e associações sobre Pythium insidiosum

Abstract

Pythiosis is a granulomatous disease of human and animals that occurs primarily in tropical and subtropical areas of the world. It is caused by an aquatic, fungus-like organism called Pythium insidiosum. The treatment for pythiosis is uncertain, with an unfavorable prognosis for human and animals. Therefore, new possibilities for treatments must be examined. We have evaluated the in vitro activities of terbinafine (0.25 to 32 mg/L) alone and in combination with caspofungin (0.5 to 128 mg/L), miconazole (0.25 to 32 mg/L), fluconazole(0.125 to 64 mg/L), ketoconazole (0.125 to 64 mg/L), amphotericin B (0.25 to 16 mg/L), fluvastatin (0.125 to 64 mg/L), rifampicin (0.25 to 64 mg/L), metronidazole (0.25 to 128 mg/L) and ibuprofen (8 to 2,048) against 17 clinical isolates of P. insidiosum. Antifungal activities were assayed by broth microdilution, based on protocol M38-A for filamentous fungi, adapted to P. insidiosum, as well as the checkerboard method. Synergisms were observed in combinations of terbinafine plus caspofungin (41.18%), fluconazole (41.18%), amphotericin B (41.18%), ketoconazole (29.41%) and miconazole (11.76%). The combinations of terbinafine plus rifampicin and terbinafine plus metronidazole were indifferent for 94.12% of strains. Terbinafine plus ibuprofen was indifferent for 82.35% of strains. Antagonisms were observed in combinations of terbinafine with fluvastatin (35.30%) or rifampicin (5.88%). The combinations of terbinafine plus caspofungin, terbinafine plus fluconazole and terbinafine plus amphotericin B may have significant therapeutic potential for treatment of pythiosis.