Comparison of Etest, chequerboard dilution and time-kill studies for the detection of synergy or antagonism between antifungal agents tested against Candida species

R E Lewis; D J Diekema; S A Messer; M A Pfaller; M E Klepser

doi:10.1093/jac/49.2.345

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Comparison of Etest, chequerboard dilution and time-kill studies for the detection of synergy or antagonism between antifungal agents tested against Candida species

Journal article

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Peer reviewed

Comparison of Etest, chequerboard dilution and time-kill studies for the detection of synergy or antagonism between antifungal agents tested against Candida species

R E Lewis, D J Diekema, S A Messer, M A Pfaller and M E Klepser

Journal of antimicrobial chemotherapy, Vol.49(2), pp.345-351

02/2002

DOI: 10.1093/jac/49.2.345

PMID: 11815578

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Abstract

Currently, there is considerable debate regarding the best in vitro method for testing antifungal combinations against Candida spp. In this study, we compared the results obtained by chequerboard dilution, time-kill studies and Etest for several antifungal combinations against Candida spp. Three Candida albicans isolates (fluconazole MICs of 1.0, 32 and >256 mg/L) and three non-albicans Candida isolates (C. glabrata, C. tropicalis and C. krusei) were tested in RPMI 1640 medium. By chequerboard testing, the majority of antifungal combinations were found to be indifferent. Notably, antagonism was identified by time-kill studies and by Etest for combinations of amphotericin B-fluconazole, but it was not detected by the chequerboard method. Pre-exposure of isolates to fluconazole did not affect results of the Etest or chequerboard method, but it did increase the frequency of antagonism noted by time-kill methods. This study indicates that chequerboard dilution testing in RPMI medium may not reliably detect the attenuation of amphotericin B activity. Of the three methods, Etest was the simplest to use and yielded reproducible results for testing antifungal combinations.

Amphotericin B - antagonists & inhibitors

Antifungal Agents - pharmacology

Candida - growth & development

Fluconazole - pharmacology

Humans

Amphotericin B - pharmacology

Microbial Sensitivity Tests - statistics & numerical data

Candida - isolation & purification

Antifungal Agents - antagonists & inhibitors

Drug Synergism

Fluconazole - antagonists & inhibitors

Candida - drug effects

Drug Therapy, Combination

Microbial Sensitivity Tests - methods

Details

Title: Subtitle: Comparison of Etest, chequerboard dilution and time-kill studies for the detection of synergy or antagonism between antifungal agents tested against Candida species
Creators: R E Lewis - Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, Texas Medical Center, 1441 Moursund Street 423, Houston, TX 77030, USA. rlewis@uh.edu
D J Diekema
S A Messer
M A Pfaller
M E Klepser
Resource Type: Journal article
Publication Details: Journal of antimicrobial chemotherapy, Vol.49(2), pp.345-351
Publisher: England
DOI: 10.1093/jac/49.2.345
PMID: 11815578
ISSN: 0305-7453
eISSN: 1460-2091
Language: English
Date published: 02/2002
Academic Unit: Infectious Diseases; Epidemiology; Pathology; Internal Medicine
Record Identifier: 9983986265102771

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