Many drugs have been described as ‘phototoxic’ but the quality of evidence is variable. Dr Kim and colleagues in Ottowa (Canada) performed a systematic review of 240 studies of 129 drugs and categorised the evidence according to a modified GRADE scale. Almost 90% of the reports of phototoxicity were based on ‘low’ or ‘very low’ quality evidence, and more rigorous tests such as photobiological evaluation and challenge-rechallenge testing were only carried out in 23% and 10% of cases respectively. Drugs found to be supported by more substantial evidence included voriconazole, NSAIDs and some antibiotics (fluoroquinolones and tetracyclins). However, the authors note that caution should still be used when prescribing any of these drugs in the long term.
Aspergillus and Fusarium are the dominant causes of fungal keratitis in tropical and subtropical regions, while Candida is more common in temperate areas. Dr Mahmoudi and colleagues in Tehran (Iran) review the aetiology, risk factors, epidemiology, clinical/laboratory diagnosis and management of this disease.
Fungal biofilms may form around indwelling medical devices such as Pickman lines or catheters, which protects the pathogen from antifungal drugs. However, conventional susceptibility testing does not account for this so other methods are required. Van Dijck and colleagues review methods and guidelines for the following:
- Susceptibility (and resistance) of fungal cultures or biofilms against antifungal or antibiofilm compounds and compound combinations
- In vivo efficacy of antifungal and antibiofilm compounds and compound combinations
- In vitro and in vivo performance of anti-infective coatings and materials to prevent fungal biofilm-related infections
