Synergistic Antifungal Efficiency of Biogenic Silver Nanoparticles with Itraconazole against Multidrug-Resistant Candidal Strains

Abstract

Fungal infections caused by multidrug-resistant strains are considered one of the leading causes of morbidity and mortality worldwide. Moreover, antifungal medications used in conventional antifungal treatment revealed poor therapeutic effectiveness and possible side effects such as hepatotoxicity, nephrotoxicity, and myelotoxicity. Therefore, the current study was developed to determine the antifungal effectiveness of green synthesized silver nanoparticles (AgNPs) and their synergistic efficiency with antifungal drugs against multidrug-resistant candidal strains. The AgNPs were greenly synthesized using the aqueous peel extract of Punica granatum. In addition, AgNPs were characterized using ultraviolet-visible spectrophotometry (UV/Vis), transmission electron microscopy (TEM), energy-dispersive X-ray spectroscopy (EDX), Fourier transform infrared spectroscopy (FT-IR), X-ray diffraction analysis (XRD), and zeta potential analysis. In this regard, UV-vis analysis indicated SPR of AgNPs at 396 nm, while the particle size distribution revealed that the average particle size was 18.567 ± 1.46 nm. The surface charge of AgNPs was found to be −15.6 mV, indicating their stability in aqueous solutions. The biofabricated AgNPs indicated antifungal activity against Candida tropicalis, C. albicans, and C. glabrata strains showing inhibitory zone diameters of 23.78 ± 0.63, 21.38 ± 0.58, and 16.53 ± 0.21 mm, respectively while their minimum inhibitory concentration (MIC) was found to be 2.5 µg/mL against C. tropicalis strain. AgNPs and itraconazole revealed the highest synergistic activity against the multidrug-resistant strain, C. glabrata, recording a synergism percentage of 74.32%. In conclusion, the biogenic AgNPs in combination with itraconazole drug exhibited potential synergistic activity against different candidal strains indicating their potential usage in the bioformulation of highly effective antifungal agents.