In-vitro evaluation of antifungal agents in the treatment of yeast peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD).

This study compared the static and kinetic activities of six antifungal agents, in broth and used dialysate, against six yeast strains known to have caused peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). Minimum inhibitory concentrations (MIC) and IC50 results show a trend towards greater activity by amphotericin B, 5-fluorocytosine, tioconazole and itraconazole in comparison to miconazole and ketoconazole although there was some strain variability. Minimum fungicidal concentrations (MFCs) of amphotericin B were less than or equal to 1mg/l, while 5-fluorocytosine and the azoles showed large discrepancies between MIC and MFC values. In kinetic studies amphotericin B was the most potent fungicidal agent. 5-fluorocytosine showed modest activity and failed to achieve total killing. The azoles demonstrated variable degrees of inhibition of C. glabrata and showed minimal activity with C. albicans. Itraconazole showed good activity against C. parapsilosis in broth. All agents, with the exception of 5-fluorocytosine, showed reduced activity in used dialysate in comparison to broth.