In vitro Activity of New Azole Luliconazole Compared to Fluconazole against Candida Strains Isolated from Oral Lesions of Cancer Patients

Abstract

Introduction: Oral candidiasis is the most common fungal infection in patient's undergone chemotherapy. The aim of this study was to investigate the incidence and causative agents of oral candidiasis along with in vitro activity of new azole luliconazole compared with fluconazole against agents of oral candidiasis in a population of cancer patients. Materials and Methods: A total of 385 oral samples from patients with various types of cancer and undergone chemotherapy were subjected to fungal culture. The yeast isolates were then identified by using PCR-RFLP method. The MIC values for fluconazole and luliconazole were determined using broth microdilution according to the M27-S3 protocol of the CLSL The MICs, MIC50, MIC90 and geometric mean (GM) values were evaluated for all the isolates. Results: Totally, 36 yeast strains were isolated which were found to be as Candida albicans (n=26; 72.2), C. glabrata (n=5; 13.8), C. kefyr (n=3; 8.3), Pichia kudriavzevii (C. krusei) (n=1; 2.8) and C. stellatoidea 1 (n=1; 2.8) species. The MICs for luliconazole against all Candida isolates ranged from 0.007 mu g/mL to 2 mu g/mL; compared to 0.25 mu g/mL to 128 mu g/mL for fluconazole. The lowest GM values were 0.85 for C. glabrata and 1.14 mu g/mL for C. kefyr isolates. The GM values of both antifungal drugs showed no significant differences between the C. albicans isolates. Conclusion: C. albicans remains the most common agent of oral candidiasis in patients with different forms of cancers. Compared to fluconazole, Luliconazole showed more activity against all Candida species and potentially can be considered as an effective antifungal agent alternative to fluconazole.