An Assessment of In Vitro Antifungal Activities of Efinaconazole and Itraconazole against Common Non-Dermatophyte Fungi Causing Onychomycosis.

Ananya Tupaki-Sreepurna,Anupma Jyoti Kindo,Vijayakishore Thanneru,Savitri Sharma,Bhavna Jishnu,Anjana Gopi,Murugan Sundaram

doi:10.3390/jof3020020

Abstract

Onychomycosis is a fungal nail infection which is relatively common and difficult to treat. Treatment modalities include nail avulsion, surgical debridement and combination therapy with oral and topical antifungal drugs. In spite of a host of available drugs, clinical cure rates remain discouraging. Drug toxicities, prolonged regimens, lack of patient compliance, and high keratin affinity of drugs are all contributive factors. Efinaconazole is a novel topical triazole antifungal agent that has shown excellent in vitro activity against both dermatophyte and non-dermatophyte fungi causing onychomycosis. This study presents the in vitro susceptibility profiles of 44 common non-dermatophyte fungi against efinaconazole and itraconazole, another azole drug used in the treatment of onychomycosis.

Highlights

Onychomycosis, a fungal nail infection affecting either the toenails or fingernails, involving any or all components of the nail structure, is typically chronic and tough to treat
Forty-four clinical isolates of non-dermatophyte fungi commonly causing onychomycosis were collected from Sri Ramachandra Medical College and Research Institute (Chennai, India), LV Prasad Eye Institute (Hyderabad, India) and Kempegowda Institute of Medical Sciences (Bengaluru, India) and used for in vitro susceptibility testing against itraconazole and efinaconazole
For Fusarium species, which are known to cause recalcitrant infections [29], efinaconazole showed roughly eight-fold more activity than itraconazole based on the geometric mean Minimum Inhibitory Concentration (MIC) of both the drugs

Summary

Introduction

Onychomycosis, a fungal nail infection affecting either the toenails (more common) or fingernails, involving any or all components of the nail structure, is typically chronic and tough to treat. When the causative agent is a dermatophyte, the infection is termed tinea unguium. Common symptoms are thickening of the nails with discoloration, brittleness or deformity and prolonged infection may be accompanied by pain under the nail and while wearing shoes, due to nail thickening or hyperkeratosis. People with these infections have been found to suffer psychosocial stress due to the cosmetic repercussions of an unhealing infection. Among the non-dermatophyte moulds, the common onychomycosis-causing fungi are Scytalidium (or Neoscytalidium), Aspergillus, Fusarium, Scopulariopsis, Paecilomyces, Pseudoallescheria, Penicillium and Alternaria species.

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