Postantifungal Effect of Antifungal Drugs against Candida: What Do We Know and How Can We Apply This Knowledge in the Clinical Setting?

Abstract

The study of the pharmacological properties of an antifungal agent integrates the drug pharmacokinetics, the fungal growth inhibition, the fungicidal effect and the postantifungal activity, laying the basis to guide optimal dosing regimen selection. The current manuscript reviews concepts regarding the postantifungal effect (PAFE) of the main classes of drugs used to treat Candida infections or candidiasis. The existence of PAFE and its magnitude are highly dependent on both the fungal species and the class of the antifungal agent. Therefore, the aim of this article was to compile the information described in the literature concerning the PAFE of polyenes, azoles and echinocandins against the Candida species of medical interest. In addition, the mechanisms involved in these phenomena, methods of study, and finally, the clinical applicability of these studies relating to the design of dosing regimens were reviewed and discussed. Additionally, different factors that could determine the variability in the PAFE were described. Most PAFE studies were conducted in vitro, and a scarcity of PAFE studies in animal models was observed. It can be stated that the echinocandins cause the most prolonged PAFE, followed by polyenes and azoles. In the case of the triazoles, it is worth noting the inconsistency found between in vitro and in vivo studies.

Prevalence of Cutaneous mycosis in Baqubah City for the period from December 2021 to April 2022

“…Nystatin appeared effectiveness against yeasts and anthropophilic dermatophytes, Goldstein and Beth [36] mentioned previously that nystatin is effective for cutaneous candidiasis but not for the treatment of dermatophytes, however it was effective for T. rubrum in present study; therefore, treatments with antifungals require a sensitivity test at laboratory of mycology to get the suitable antifungal and dose for the patients [37].…”

Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use

“…The potential of drug interactions is negligible as well as the risk of resistance selection. It has concentration-dependent fungicidal activity, a prolonged half-life and showed an extended post-antifungal effect in time-kill studies [226]. Moreover, due to the lipophilic characteristics, it might be less affected by pathophysiological changes than hydrophilic drugs like echinocandins.…”

In Vitro Susceptibility Tests in the Context of Antifungal Resistance: Beyond Minimum Inhibitory Concentration in Candida spp.

“…This standardized procedure was adopted in other experiments where changes were applied only to incubation time after disposal of the fungal suspension on solid medium according to the species-specific time of growth [113,114]. Results from multiple studies conducted on PAFE showed that this phenomenon was largely influenced by the species, the class of molecule, as AMB and echinocandin showed prolonged inhibition of growth after removal, and drug concentration, as higher PAFE was registered with higher antifungal concentrations [114,115].…”

“…From a clinical and pharmacological standpoint, PAFE influences the timing of antifungal drug administration, with drugs with prolonged PAFE requiring a lower dosing per day [111,115]. On the other hand, PAFE-induced prolonged inhibition of growth might alter the results of fungicidal in vitro tests, as microorganisms whose growth was only PAFE-inhibited were not actually killed.…”