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Antifungal Combinations in Dermatophytes

Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, 60020 Ancona, Italy
Malattie Infettive, Azienda Ospedaliera Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy
Author to whom correspondence should be addressed.
Academic Editors: Patrick Schwarz and Eric Dannaoui
J. Fungi 2021, 7(9), 727;
Received: 10 August 2021 / Revised: 31 August 2021 / Accepted: 1 September 2021 / Published: 5 September 2021
(This article belongs to the Special Issue Antifungal Combinations in Fungal Infections)
Dermatophytes are the most common cause of fungal infections worldwide, affecting millions of people annually. The emergence of resistance among dermatophytes along with the availability of antifungal susceptibility procedures suitable for testing antifungal agents against this group of fungi make the combinatorial approach particularly interesting to be investigated. Therefore, we reviewed the scientific literature concerning the antifungal combinations against dermatophytes. A literature search on the subject performed in PubMed yielded 68 publications: 37 articles referring to in vitro studies and 31 articles referring to case reports or clinical studies. In vitro studies involved over 400 clinical isolates of dermatophytes (69% Trichophyton spp., 29% Microsporum spp., and 2% Epidermophyton floccosum). Combinations included two antifungal agents or an antifungal agent plus another chemical compound including plant extracts or essential oils, calcineurin inhibitors, peptides, disinfectant agents, and others. In general, drug combinations yielded variable results spanning from synergism to indifference. Antagonism was rarely seen. In over 700 patients with documented dermatophyte infections, an antifungal combination approach could be evaluated. The most frequent combination included a systemic antifungal agent administered orally (i.e., terbinafine, griseofulvin, or azole—mainly itraconazole) plus a topical medication (i.e., azole, terbinafine, ciclopirox, amorolfine) for several weeks. Clinical results indicate that association of antifungal agents is effective, and it might be useful to accelerate the clinical and microbiological healing of a superficial infection. Antifungal combinations in dermatophytes have gained considerable scientific interest over the years and, in consideration of the interesting results available so far, it is desirable to continue the research in this field. View Full-Text
Keywords: dermatophytes; antifungals; antifungal susceptibility testing; drug combinations dermatophytes; antifungals; antifungal susceptibility testing; drug combinations
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MDPI and ACS Style

Brescini, L.; Fioriti, S.; Morroni, G.; Barchiesi, F. Antifungal Combinations in Dermatophytes. J. Fungi 2021, 7, 727.

AMA Style

Brescini L, Fioriti S, Morroni G, Barchiesi F. Antifungal Combinations in Dermatophytes. Journal of Fungi. 2021; 7(9):727.

Chicago/Turabian Style

Brescini, Lucia, Simona Fioriti, Gianluca Morroni, and Francesco Barchiesi. 2021. "Antifungal Combinations in Dermatophytes" Journal of Fungi 7, no. 9: 727.

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