Effective Combinations Against Efflux Pump Overexpressed on Azole Resistance Candida and Dermatophytes: A Systematic Review

Abstract

Dermatophytes and Candida are the two most common causes of fungal infections worldwide, affecting millions of people annually. The emergence of resistance among these groups of fungi and the limited availability of effective antifungal drugs may become a real challenge in the coming era. Thus, use of a combination of resistant reversion agents along with antifungal drugs is worth investigating. One of the causes of resistance development is the overexpression of efflux pumps and associated genes. Therefore, we examined the scientific literature on antifungal combinations against resistant species of dermatophytes and Candida caused by efflux pump overexpression. A literature search on the subject performed in PubMed and Google scholar resulted from a total of sixteen relevant publications. The inclusion criteria mainly focused on dermatophyte and Candida strains resistant to azoles, as well as publications that combined antifungal medications with natural compounds or other chemicals to combat resistance. Out of sixteen, fourteen articles focused on resistant strains of Candida and two on dermatophytes. Among articles published on resistant strains of Candida, five articles were based on combining azole with other drugs, while nine were with natural compounds like essential oils, curcumin etc. Whereas with resistant strains of dermatophytes, both articles were based on combining azole with natural compounds. It can be concluded that antifungal combinations against resistant strains of Candida and dermatophytes are more effective than single drugs. Combinatorial approaches have gained considerable scientific interest over the years, with promising results. Thus, it is worthwhile to continue research in this area.