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Abstract

ANTIFUNGAL DRUG RESISTANCE IN CANDIDA SP. – A REVIEW

Kavitha M. K.*

ABSTRACT

Antifungal drug resistance is problematic as initial diagnosis of systemic fungal infection may be delayed and the choice of antifungal drugs remains limited due to the emergence of resistant fungal species. Four classes of antifungal drugs are most widely used in clinical practice to treat systemic fungal infections and there are four main antifungal drug targets in C.albicans. Antifungal drug resistance can be divided into two categories: clinical resistance and in vitro resistance. Mechanisms of antifungal resistance are either primary or secondary, and are related to intrinsic or acquired characteristics of the fungal pathogen that interfere with the antifungal mechanism of the drug. Resistance can also occur when environmental factors lead to replacement of a susceptible species with a resistant one. Most of the established antifungal resistance mechanisms are due to genetic mutation – usually point mutations in genes encoding drug targets or enzymes in metabolic pathways, or transcription factors leading to gene over expression. Such mutations are stable, take time to be acquired, and can be considered as long-term stress responses. Antifungal resistance has consequences associated with poor clinical outcome during antifungal treatment and prophylaxis. Strategies to overcome antifungal drug resistance include the synthesis of new drugs with better antifungal activity. In addition, antifungalcontrol programmes to avoid extensive and inappropriate use of antifungal may be needed. Early identification of Candida sp. from clinical specimens and standard antifungal drug susceptibility testing would be an effective approach for controlling outbreaks caused by C.albicans and Non albicans Candida species. Application of standard techniques, guidelines for the use of antifungal agents and control measures for predisposing factors may reduce the risk of drug-resistant Candida infections.

Keywords: Antifungal drug, drug targets, drug resistance, Candida sp.


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