Itraconazole and terbinafine have been approved in the

USA and amorolfine and fluconazole have been approved in Europe for treatment of onychomycoses [2]. Onychomycoses are often recurrent, chronic, and generally require long-term treatment with antifungal agents [4]. It is desirable to choose appropriate antifungal drugs in the early stages of infection. In addition, it is practical to consider appropriate combinations of internal and external antifungal drugs with different pharmacological effects to treat refractory fungal infection, especially onychomycosis. There have been many previous studies of double or triple drug combination therapy [3-17]. These reports suggest the usefulness of combinations of external and internal antifungal agents; however, Tigecycline purchase there have been few reports presenting quantitative data regarding drug combinations in vitro [6, 7, 9]. Here, we investigated the susceptibility of major dermatophytes and non-dermatophytic fungi responsible for superficial fungal infection to six antifungal agents: amorolfine, terbinafine, butenafine, ketoconazole, itraconazole and bifonazole. We also investigated the synergistic find protocol or additive effect of an antifungal combination. We choose two antifungals in common use, amorolfine and itraconazole, which have different mechanisms of actions and administration routes (amorolfine is

an external agent for topical use and itraconazole an internal agent for systemic use). We used the FIC index to quantify the efficacy of a combination

of amorolfine and itraconazole in 27 strains of dermatophytes. The strains investigated in this study are shown in Table 1 (Cl-I- and Sz-k- were clinical isolates). One standard strain (TIMM2789, T. mentagrophytes (Arthroderma vanbreuseghemii)) and 43 clinical isolates of major pathogenic dermatophytes were used; namely, 14 strains of T. rubrum, 14 strains of T. mentagrophytes human type [18] (synonym, Trichophyton interdigitale (anthropophilic)) [19], three strains of Trichophyton tonsurans, one strain of T. verrucosum, two strains of M. canis, four strains of M. gypseum and five strains of E. floccosum. In addition, 10 strains of non-dermatophytes Interleukin-2 receptor were also used; namely, two strains of Aspergillus fumigatus, two strains of Geotrichum candidum, two strains of Scopulariopsis brevicaulis, two strains of Fusarium oxysporum, one strain of Fusarium verticillioides and one strain of Fusarium solani. All isolates were identified using a molecular-based method reported previously [18-21]. The test isolates were subcultured onto 1/10 Sabouraud dextrose agar (peptone, 1 g; glucose, 4 g; distilled water, 1 L; agar, 15 g; pH 6.0) plates and incubated at 30°C for 7 days. Some poor growth strains were cultivated for extended times of up to 14 days.