In-vitro resistance to imidazole antifungals in Candida albicans

Three strains of Candida albicans from patients with chronic mucocutaneous candidosis (CMC) who relapsed during prolonged treatment with ketoconazole were compared with three other Can. albicans strains by means of an agar incorporation MIC method, a broth microdilution method for IC30 determination, and a hyphal elongation assessment method. The MICs of ketoconazole, tioconazole and miconazole were difficult to interpret, but were much higher for the three CMC strains if low inoculum concentrations and short incubation times were used. The IC50s of the three imidazoles were much higher for the CMC strains than for the others. The imidazoles all caused minimal inhibition of hyphal elongation by the three CMC strains at concentrations up to 50 mg/l. Concentrations of 0.5 mg/l caused marked inhibition of the other strains.