Synergy of fluconazole with macrophages for antifungal activity againstCandida albicans

The possible synergy between macrophages and fluconazole for antifungal activity against different isolates ofC. albicans was studied. The susceptibility ofC. albicans isolates to fluconazole (FCZ), when incubated in RPMI-1640 with 10% fetal bovine serum (FBS) and 10% fresh mouse serum (test medium, TM) was determined by using a quantative culture methodology. Multiplication of isolate Sh27 was strongly inhibited by FCZ, even at 1.0 µg/ml. However, FCZ even at 100 µg/ml was not fungicidal. Resident murine peritoneal macrophages (MP) incubated for 48 h in RPMI-1640+10% FBS (tissue culture medium, TCM), then challenged with Sh27 in TM for 24 h, were fungistatic (20±9%,n=4). Cultured macrophages synergized with FCZ (10 µg/ml) for fungicidal activity when co-cultured with Sh27 in TM for 24 h (46±8%) and for 48 h (74±5%),n=3. Macrophages and FCZ (10 µg/ml) could not synergize for significant killing of a less FCZ-sensitiveC. albicans isolate 94-164. Multiplication of a FCZ-resistant isolate (94–20) was not inhibited by FCZ at 10 µg/ml TM; however, macrophages and FCZ (10 µg/ml) could synergize for fungistatic (64%), but not fungicidal, activity.