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Journal of Clinical Microbiology, April 2002, p. 1406-1412, Vol. 40, No. 4
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.4.1406-1412.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

In Vitro Activity of Nystatin Compared with Those of Liposomal Nystatin, Amphotericin B, and Fluconazole against Clinical Candida Isolates

Sevtap Arikan,^1* Luis Ostrosky-Zeichner,¹ Mario Lozano-Chiu,^1, Victor Paetznick,¹ David Gordon,^2, Tom Wallace,^2, and John H. Rex¹

Division of Infectious Diseases, Department of Internal Medicine, Center for the Study of Emerging and Reemerging Pathogens, University of Texas Medical School, Houston, Texas 77030,¹ Aronex Pharmaceuticals, Inc., The Woodlands, Texas 77381²

Received 20 April 2001/ Returned for modification 18 September 2001/ Accepted 9 January 2002

We investigated the in vitro activity of nystatin and liposomal nystatin against 103 Candida isolates to determine the effect of both time and medium on MICs. We also compared the nystatin MICs with those of amphotericin B and fluconazole. Testing was performed in accordance with the National Committee for Clinical Laboratory Standards M27-A microdilution methodology with RPMI 1640, RPMI 1640 supplemented with glucose to 2% (RPMI-2), and antibiotic medium 3 supplemented with glucose to 2% (AM3). While nystatin MICs were similar to or slightly lower than liposomal nystatin MICs in RPMI 1640 and RPMI-2, they were markedly higher than liposomal nystatin MICs in AM3. Use of AM3 and determination of the MIC after 24 h of incubation provided a slightly wider range of liposomal nystatin MICs (0.06 to >16 µg/ml). Under these conditions, the MICs at which 90% of isolates were inhibited of nystatin and liposomal nystatin were 2 and 1 µg/ml, respectively. Nystatin and liposomal nystatin in general showed good activity against all Candida spp. tested. Although the MICs of nystatin and liposomal nystatin tended to rise in parallel with the amphotericin B MICs, nystatin and liposomal nystatin MICs of 1 to 2 and 0.5 to 1 µg/ml, respectively, were obtained for seven and six, respectively, of nine isolates for which amphotericin B MICs were 0.25 µg/ml. No correlation between fluconazole and nystatin or liposomal nystatin MICs was observed. As amphotericin B MICs of 0.25 µg/ml correlate with in vitro resistance, these results suggest that liposomal nystatin might have activity against some amphotericin B-resistant isolates. In vivo testing in animal models is required for clarification of this issue.

Present address: Glaxo Wellcome Pharmaceuticals, Departmento de Investigacion, Madrid, Spain.

Present address: MithraTech, Inc., Houston, TX 77030.

Present address: Roche Pharmaceuticals, Department of Medical Affairs, Nutley, NJ 07110.

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