# Antifungal Drug Efficacy Profiles Against Vaginal Candida albicans: A Multi-Drug Comparative Analysis

## TL;DR

This study compares the effectiveness of six antifungal drugs against vaginal Candida albicans infections in Saudi Arabia, finding that amphotericin B and itraconazole are most effective while fluconazole shows high resistance.

## Contribution

The study provides updated local susceptibility profiles of antifungal drugs against Candida albicans isolates in Saudi Arabia.

## Key findings

- Amphotericin B and itraconazole showed the lowest MIC and MFC values, indicating strong antifungal activity.
- Fluconazole exhibited high resistance with 85% resistance rate and elevated MIC and MFC values.
- Statistical analysis confirmed significant differences in drug effectiveness (p < 0.001).

## Abstract

Background: Candida albicans infects most reproductive-aged women, causing a prevalent infection known as Vulvovaginal Candida. As there has been an increase in resistance to widely used antifungal agents, particularly fluconazole, used in infections, local susceptibility profiles are needed to inform treatment options. Methods: This comparative observational study was carried out to determine the in vitro susceptibility of six antifungal compounds [fluconazole, voriconazole, itraconazole, ketoconazole, nystatin, and amphotericin B] to 163 vaginal Candida albicans isolates obtained in three hospitals in Tabuk, Saudi Arabia. MIC50, MIC90, and MFC values were calculated in Broth microdilution tests according to the standards of CLSI M27-A3. Friedman and Wilcoxon signed-rank tests were used to carry out statistical analysis. Results: It was observed that Amphotericin B and itraconazole recorded the lowest MIC and MFC, revealing better antifungal action. The worst performer was fluconazole with MIC50 (13.79 μg/mL), MIC90 (27.59 μg/mL), and MFC (37.93 μg/mL), and 85% resistance. It was found that there are significant differences between antifungal agents (p < 0.001), and amphotericin B and itraconazole always performed best compared to fluconazole and voriconazole. Conclusions: The results shows antifungal effectiveness as Amphotericin B and itraconazole are the most effective against vaginal Candida albicans isolates. There is a high rate of resistance to fluconazole, suggesting it should no longer be the first choice of treatment in this area. These findings highlight the need for local monitoring of drug resistance to guide treatment choices and emphasize the importance of using antifungals properly to prevent increased resistance.