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Acta Médica Costarricense

On-line version ISSN 0001-6002Print version ISSN 0001-6012


ACOSTA-ZAMORA, Armando  and  JAIKEL-VIQUEZ, Daniela. Combined activity of Itraconazole and Terbinafine over clinical isolates of Neoscytalidium dimidiatum. Acta méd. costarric [online]. 2021, vol.63, n.1, pp.43-50. ISSN 0001-6002.


Study the combined susceptibility patterns of Neoscytalidium dimidiatum to the effect of Itraconazole and Terbinafine.


The Minimum Inhibitory Concentration and Fractional Inhibitory Concentration were determined in vitro by the chessboard method for 15 clinical isolates of onychomycosis, from different patients, all positives for N. dimidiatum. Duplicated trials were prepared with combined dilutions of antifungals and the effect of both drugs was evaluated.


The average Minimum Inhibitory Concentration of Itraconazole when applied alone for the isolates was 30.83 μg/mL and 4.49 μg/mL when combined with Terbinafine. The average Minimum Inhibitory Concentration of Terbinafine alone was 0.33 μg/mL and 0.07 μg/mL when combined with Itraconazole. Statistically significant differences were found between the average Minimum Inhibitory Concentrations of the antifungals analyzed alone versus the Minimum Inhibitory Concentrations obtained by mixing both compounds. That is for Itraconazole (t = 2,958; gl = 14; p = 0,01) and (t = 4,721; gl = 14; p <0,001) for Terbinafine. Combined use showed 40 % synergism.


The Itraconazole-Terbinafine combination had synergistic effect to inhibit the growth of N. dimidiatum, which offers a therapeutic alternative in the treatment of onychomycoses caused by this fungus.

Keywords : Onychomycosis; Itraconazole; Terbinafine; Combined Modality Therapy.

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