Lipid-based amphotericin B gel treatment eradicates vulvovaginal candidiasis in patients who failed to azole therapy

Sheikh, Saifuddin; Ahmad, Ateeq; Ali, Shoukath M.; Paithankar, Mahesh; Patel, Ronak; Chuadhari, Shushil; Dave, Purvi M; Bhomia, Mamta V; Desai, Jagruti Y; Munshi, Atul; Shah, Meenakshi N; Desai, Kirankumar R; Dongre, Swati A; Walvekar, Shraddha A; Ahmad, Imran

doi:10.1007/s00403-023-02583-9

Cited by 2 publications

(1 citation statement)

References 12 publications

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“…Indeed, several studies have recognized the efficacy of either intravenous administration [38] or bladder irrigation with amphotericin [34] for Candida UTIs despite potential counter-indications. Similar observations were made with vulvovaginal candidiasis (VVC), where amphotericin has been used in cases of recurrence [53] or treatment failure with azole compounds [54] and shows much lower resistance [55]. Indeed, our approach could be used for VVC, as artificial vaginal fluid mediums have been described and can be made readily [56].…”

Section: Discussionsupporting

confidence: 64%

Again and Again—Survival of Candida albicans in Urine Containing Antifungals

Facchini,

Wernli,

Rieken

et al. 2024

Pharmaceutics

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Background: Relapse of Candida albicans urinary tract infection (UTI) is frequent despite appropriate treatment, as commonly used antifungals such fluconazole and flucytosine are only fungistatics. To improve treatment of Candida UTI and decrease relapses, understanding the long-term metabolic activity and survival of C. albicans in urine containing antifungals at minimal inhibitory concentration (MIC) is needed. Methods: we monitored the survival, metabolic activity and consumption of glucose and proteins by C. albicans using conventional methods and isothermal microcalorimetry (IMC). We also investigated the influence of dead Candida cells on the growth of their living counterparts. Results: For 33 days, weak activity was observed in samples containing antifungals in which C. albicans growth rate was reduced by 48%, 60% and 88%, and the lag increased to 172 h, 168 h and 6 h for amphotericin, flucytosine and fluconazole, respectively. The metabolic activity peaks corresponded to the plate counts but were delayed compared to the exhaustion of resources. The presence of dead cells promoted growth in artificial urine, increasing growth rate and reducing lag in similar proportions. Conclusions: Even with antifungal treatment, C. albicans relapses are possible. The low metabolic activity of surviving cells leading to regrowth and chlamydospore formation possibly supported by autophagy are likely important factors in relapses.

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