Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Antifungal Combinations in Dermatophytes

Version 1 : Received: 10 August 2021 / Approved: 12 August 2021 / Online: 12 August 2021 (13:16:42 CEST)

A peer-reviewed article of this Preprint also exists.

Brescini, L.; Fioriti, S.; Morroni, G.; Barchiesi, F. Antifungal Combinations in Dermatophytes. J. Fungi 2021, 7, 727. Brescini, L.; Fioriti, S.; Morroni, G.; Barchiesi, F. Antifungal Combinations in Dermatophytes. J. Fungi 2021, 7, 727.


Dermatophytes are the most common cause of fungal infections worldwide, affecting millions of people annually. The emergence of resistance among dermatophytes along with the availability of antifungal susceptibility procedures suitable for testing antifungal agents against this group of fungi make the combinatorial approach particularly interesting to be investigated. Therefore, we reviewed the scientific literature concerning the antifungal combinations in dermatophytes. A literature search on the subject performed in PubMed yielded 68 publications: 37 articles referring to in vitro studies, and 31 articles referring to case reports/clinical studies. In vitro studies involved over 400 clinical isolates of dermatophytes (69% Trichophyton spp., 29% Microsporum spp., and 2% Epidermophyton floccosum). Combinations included two antifungal agents or an antifungal agent plus another chemical compound including plant extracts/essential oils, calcineurin inhibitors, peptides, disinfectant agents and others. In general, drug combinations yielded variable results spanning from synergism to indifference. Antagonism was rarely seen. In over 700 patients with documented dermatophyte infections an antifungal combination approach could be evaluated. The most frequent combination included a systemic antifungal agent administered orally (i.e.: azole [mainly itraconazole], terbinafine or griseofulvin) plus a topical medication (i.e.: azole, terbinafine, ciclopirox, amorolfine) for several weeks. Clinical results indicate that association of antifungal agents is effective, and it might be useful in accelerate the clinical and microbiological healing of a superficial infection. Antifungal combinations in dermatophytes have gained considerable scientific interest over the years and, in consideration of the interesting results available as far, it is desirable to continue the research in this field.


dermatophytes; antifungals; antifungal susceptibility testing; drug combination


Biology and Life Sciences, Immunology and Microbiology

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