Antifungal Activity Assessment of Selected Locally Sold Over-The-Counter Azole against Candida Isolates from Hospital and Community Settings of Rivers State, Nigeria

Abstract

There seems to be multiple factors that could affect the performance of a drug which may range widely from measurements to packaging, storage, handling and standardization. Candida species are ubiquitous in nature and are found at different parts of the body, with some present as normal flora. However, drug abuse as mostly associated with the conscious intake of drugs without the guide or prescription of a physician, poses enormous challenge to personal and public health. Hence, this study was designed for comparative analysis of the antifungal activity of over the counter azole and standardized fluconazole disc on the Candida species isolated from community and hospital settings in Rivers State. All Candida isolates were inoculated onto a Sarbouraud dextrose agar plate to obtain a pure culture and then used for normal saline microscopy, germ tube test and carbohydrate assimilation tests to confirm Candida species. Antifungal susceptibility testing using the Kirby Bauer disc diffusion method was carried out and the data generated were type-set in Microsoft Excel version 2003, and transferred into statistical package for social sciences (SPSS), IBM version 21 for statistical analysis. The study results showed 59 Candida isolates with 11.9% Candida isolated testing negative to germ tube test while 88.1% of the tested positive to germ tube test. However, distribution of germ tube positive Candida species from hospital and community settings showed that the community setting had 90.6% germ tube positive Candida isolates and 9.4% germ tube negative Candida isolates while hospital settings showed 85.2% germ tube positive isolates and 14% germ tube negative isolates. In this study, 28.6% Non-albicans Candida (NAC) were susceptible to clotrimazole, 14.3% NAC were susceptible dose dependent while 57.1% were resistant to clotrimazole. However, fluconazole recorded 0% susceptibility dose dependence by Non-albicans Candida, 42.9% susceptibility and 57.1% resistance. Similarly, 63.5%, 15.4%, and 21.2% of Candida albicans were susceptible, susceptibility dose dependent and resistant respectively to fluconazole. While, 30.8%, 34.6% and 34.6% of Candida albicans were susceptible, susceptibility dose dependent and resistant to itraconazole. In conlusion, fluconazole had the best efficacy on non-albicans Candida while clotrimazole was best for killing Candida albicans It is believed that a change in attitude from self medication is very crucial as it remains a key factor that could be responsible for increased incidence of Candida species’ resistance to azole therapy. Furthermore, change towards adherence to antifungal drug regimes when encouraged and cultivated as a positive habit for all patients, could enhance monitoring of drug efficacy and clinical/treatment outcomes.