Breakpoints for the Classification of Anti-Candida Compounds in Antifungal Screening

Abstract

Introduction. The absence of a standardized classification scheme for the antifungal potency of compounds screened against Candida species may hinder the study of new drugs. This systematic review proposes a scheme of interpretative breakpoints for the minimum inhibitory concentration (MIC) of bioactive compounds against Candida species in in vitro tests. Materials and Methods. A literature search was conducted in the PubMed, Scopus, Web of Science, Lilacs, and SciFinder databases for the period from January 2015 to April 2020. The following inclusion criterion was used: organic compounds tested by the microdilution technique according to the Clinical and Laboratory Standards Institute protocol against reference strains of the genus Candida. A total of 545 articles were retrieved after removing duplicates. Of these, 106 articles were selected after applying the exclusion criteria and were evaluated according to the number of synthesized molecules and their chemical classes, the type of strain (reference or clinical) used in the antifungal test, the Candida species, and the MIC (in μg/mL) used. Results. The analysis was performed based on the median, quartiles (25% and 75%), maximum, and minimum values of four groups: all strains, ATCC strains, C. albicans strains, and C. albicans ATCC strains. The following breakpoints were proposed to define the categories: $\text{MIC}<3.515\mu \text{g}/\text{mL}$ (very strong bioactivity); 3.516-25 μg/mL (strong bioactivity); 26-100 μg/mL (moderate bioactivity); 101-500 μg/mL (weak bioactivity); 500-2000 μg/mL (very weak bioactivity); and >2000 μg/mL (no bioactivity). Conclusions. A classification scheme of the antifungal potency of compounds against Candida species is proposed that can be used to identify the antifungal potential of new drug candidates.