The concentration-dependent nature of in vitro amphotericin B-itraconazole interaction against Aspergillus fumigatus: isobolographic and response surface analysis of complex pharmacodynamic interactions

Int J Antimicrob Agents. 2006 Nov;28(5):439-49. doi: 10.1016/j.ijantimicag.2006.07.011. Epub 2006 Oct 19.

Abstract

The interaction between polyenes and azoles is not well understood. We therefore explored the in vitro combination of amphotericin B with itraconazole against 14 clinical Aspergillus fumigatus isolates (9 itraconazole susceptible and 5 itraconazole resistant) with a colorimetric broth microdilution checkerboard technique using two drug interaction models able to explore complicated patterns of interactions: the response surface analysis of Bliss independence and the isobolographic analysis of Loewe additivity zero interaction theories. Synergy was found at combinations with low concentrations of amphotericin B (<0.125 mg/L), whereas antagonism was found at combinations with higher concentrations of amphotericin B. For itraconazole-resistant isolates, synergistic interactions were observed at high concentrations of itraconazole (>0.5 mg/L). Synergy was more frequently observed for the itraconazole-resistant isolates than for the itraconazole-susceptible isolates.

MeSH terms

  • Algorithms
  • Amphotericin B / pharmacology*
  • Aspergillus fumigatus / drug effects*
  • Dose-Response Relationship, Drug
  • Drug Antagonism
  • Drug Interactions
  • Drug Resistance, Fungal
  • Drug Synergism
  • Humans
  • Itraconazole / pharmacology*
  • Microbial Sensitivity Tests
  • Models, Biological*

Substances

  • Itraconazole
  • Amphotericin B