Mediprobe Research Inc., 645 Windermere Road, London, ON, N5X 2P1, Canada.
Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Canada.
Am J Clin Dermatol. 2021 Mar;22(2):149-157. doi: 10.1007/s40257-020-00580-6. Epub 2020 Dec 22.
Superficial mycoses are becoming increasingly resistant to current antifungal medications. As alternative therapeutic options are limited, the increasing frequency of reports of antifungal resistance is alarming. This epidemic parallels the rise of antibiotic resistance; however, the significance of this problem has yet to gain global attention. Here, we discuss the reports of antifungal resistance from around the world, present our own experience with treatment-resistant infections, and examine alternative treatment strategies. The majority of reports of recalcitrant infections indicate terbinafine resistance as the causative factor. Single-point mutations in the squalene oxidase gene is the most reported mechanism of resistance to terbinafine. Mixed infections of dermatophytes with non-dermatophyte molds and/or yeasts are becoming more prevalent and contributing to the resistant nature of these infections. The key to selecting an effective antifungal therapy for a recalcitrant infection is identification of the infectious organisms(s) and testing susceptibility of the organism(s) to antifungal drugs. Combination and sequential therapy regimens are options, but both require active monitoring for hepatic and renal function, drug interactions, and other adverse effects. Selected topical antifungals with a wide spectrum of activity may also be considerations in some clinical presentations. Innovative treatment regimens and novel therapeutics are needed to overcome the rising epidemic of antifungal resistance.
浅部真菌病对目前的抗真菌药物的耐药性日益增强。由于替代治疗选择有限，抗真菌耐药性的报告频率不断增加令人震惊。这种流行趋势与抗生素耐药性的上升相吻合；然而，这个问题的重要性尚未引起全球关注。在这里，我们讨论了来自世界各地的抗真菌耐药性报告，介绍了我们自己对抗真菌治疗耐药感染的经验，并研究了替代治疗策略。大多数难治性感染报告表明，特比萘芬耐药是导致感染的原因。角鲨烯氧化酶基因的单点突变是特比萘芬耐药最常见的机制。皮肤癣菌与非皮肤癣菌霉菌和/或酵母的混合感染越来越普遍，导致这些感染具有耐药性。选择难治性感染有效抗真菌治疗的关键是确定感染的生物体，并测试生物体对抗真菌药物的敏感性。联合和序贯治疗方案是可选的，但两者都需要积极监测肝肾功能、药物相互作用和其他不良反应。在某些临床表现中，也可以考虑选择具有广谱活性的局部抗真菌药物。需要创新的治疗方案和新的治疗方法来克服抗真菌耐药性的不断上升。
