Fenticonazole: an effective topical treatment for superficial mycoses as the first-step of antifungal stewardship program.

The resistance of microorganisms to antimicrobial drugs is a major issue for public health, with important consequences in terms of morbidity, mortality and resource use. The phenomenon is so serious that in some areas of the world resistant strains to all available drugs have been selected. Many conditions may result in the development of resistance: they include the indiscriminate or inappropriate (e.g., for viral infection or colonization) use of antibiotics, the excessive duration of the prescribed treatment regimens, as well as inadequate dosing or administration routes. Resistance is well-known, but less studied, also for infections caused by fungi. In the last decade, an impressive outbreak of candidiasis due to non-albicans strains (with variable patterns of resistance to azoles) was observed. This outbreak was likely associated with inappropriate use of oral azoles for the treatment of non-complicated candidiasis, such as vulvovaginal candidiasis or Candida dermatitis. In this setting, fenticonazole may represent an effective topical drug for the treatment of mycotic infections of skin and mucosa. Topical treatment of superficial mycoses still holds a major importance as it helps reduce the exposure to oral systemic azoles - mainly fluconazole and itraconazole - of intestinal microbiota, which represents the main human reservoir of yeasts. This strategy can contribute to reduce the selection of resistant strains of Candida, within the context of a really-effective antifungal stewardship program.