The Growing Problem of Antifungal Resistance in Onychomycosis and Other Superficial Mycoses.
Administration, Oral
Administration, Topical
Antifungal Agents
/ pharmacology
Arthrodermataceae
/ drug effects
Drug Monitoring
Drug Resistance, Fungal
Drug Therapy, Combination
/ methods
Foot Dermatoses
/ drug therapy
Hand Dermatoses
/ drug therapy
Humans
Microbial Sensitivity Tests
Onychomycosis
/ drug therapy
Terbinafine
/ pharmacology
Treatment Outcome
Journal
American journal of clinical dermatology
ISSN: 1179-1888
Titre abrégé: Am J Clin Dermatol
Pays: New Zealand
ID NLM: 100895290
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
accepted:
28
11
2020
pubmed:
24
12
2020
medline:
13
7
2021
entrez:
23
12
2020
Statut:
ppublish
Résumé
Superficial mycoses are becoming increasingly resistant to current antifungal medications. As alternative therapeutic options are limited, the increasing frequency of reports of antifungal resistance is alarming. This epidemic parallels the rise of antibiotic resistance; however, the significance of this problem has yet to gain global attention. Here, we discuss the reports of antifungal resistance from around the world, present our own experience with treatment-resistant infections, and examine alternative treatment strategies. The majority of reports of recalcitrant infections indicate terbinafine resistance as the causative factor. Single-point mutations in the squalene oxidase gene is the most reported mechanism of resistance to terbinafine. Mixed infections of dermatophytes with non-dermatophyte molds and/or yeasts are becoming more prevalent and contributing to the resistant nature of these infections. The key to selecting an effective antifungal therapy for a recalcitrant infection is identification of the infectious organisms(s) and testing susceptibility of the organism(s) to antifungal drugs. Combination and sequential therapy regimens are options, but both require active monitoring for hepatic and renal function, drug interactions, and other adverse effects. Selected topical antifungals with a wide spectrum of activity may also be considerations in some clinical presentations. Innovative treatment regimens and novel therapeutics are needed to overcome the rising epidemic of antifungal resistance.
Identifiants
pubmed: 33354740
doi: 10.1007/s40257-020-00580-6
pii: 10.1007/s40257-020-00580-6
doi:
Substances chimiques
Antifungal Agents
0
Terbinafine
G7RIW8S0XP
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
149-157Références
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