In vitro susceptibility of chromoblastomycosis agents to antifungal drugs: A systematic review.


Postgraduate Program in Medicine, Medical Sciences, Department of Microbiology, Immunology and Parasitology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. Electronic address: [Email]


Chromoblastomycosis (CBM) is a chronic granulomatous mycosis caused by dematiaceous fungi that affects cutaneous and subcutaneous tissues. The standard antifungal drug for treatment is itraconazole, followed by terbinafine. However, cure rates vary from 15% to 80% when these drugs are used as monotherapy. A systematic review of the in vitro susceptibility of CBM agents to antifungal drugs, alone and in combination, was conducted using the Cochrane methodology. Forty-seven search terms were included in the PICOS method of searching electronic databases. The search resulted in 35 studies, of which 8 evaluated antifungal drugs in combination. Based on minimum inhibitory concentrations (MICs), posaconazole, terbinafine, itraconazole and voriconazole were, in descending order, the most effective antifungal drugs against CBM agents in vitro. In drug combination studies, only terbinafine-voriconazole and itraconazole-caspofungin showed 100% synergy for Fonsecaea pedrosoi, Exophiala jeanselmei and Phialophora verrucosa. However, none of the combinations studied showed antagonism.


Antifungal therapy,Chromoblastomycosis,Combination therapy,Susceptibility,