The reading of the MIC for anidulafungin was optimal under hypoxic conditions. Results presented by Furletti et al. 61 showed that C. albicans isolated from periodontal pockets were resistant to amphotericin B and sensitive to fluconazole. This result shows that there may be difficulty in the infusion of the drug in the periodontal space or resistant strains may be due to overexpression Selisistat ic50 of efflux genes. Jewtuchowicz et al.56 studied isolates of C. albicans and C. dubliniensis in patients with and without

periodontitis and consistently found that only one isolate was resistant to fluconazole and voriconazole. C. albicans appears to be contributing to bacterial biofilm formation on these structures and hindering the penetration

of certain antimicrobial drugs. 47 Still, for these studies, C. albicans was found typically in the outer layers of the biofilm, and seemed to act according as expected, as a barrier protecting the microorganisms of the deep interior from the action of immune mechanisms, aiding the resistance of the subgingival microbiota in the face of host defences, and contributing to the persistence of inflammation in adjacent tissues. Biofilms of C. albicans were highly resistant to the clinical action Sirolimus of antifungal and antimicrobial agents, including amphotericin B, chlorhexidine, nystatin and fluconazole. 72 In that work, it was demonstrated that as the C. albicans biofilms matured, there was concurrent acquisition and increased resistance of yeast cells in relation

to the antimicrobials. The prophylactic use of fluconazole in low doses has been Megestrol Acetate recommended for preventing fungal infections in immunocompromised patients. However, this has led to the selection of yeast microbes that are resistant to this antifungal agent, causing this resistance to appear in non-albicans species such as C. glabrata and C. krusei, in addition to having the sensitive C albicans be replaced by another of the same species that is fluconazole-resistant and to become resistant to fluconazole during treatment. 73 and 74 From a clinical standpoint, the most important feature of biofilm growth is the resistance to antimicrobial agents exhibited by organisms. 75 and 76 Studies have shown that biofilms formed by Candida species were more resistant to major antifungal agents used in the clinic, such as amphotericin B, fluconazole, itraconazole, and ketoconazole. 77 New azoles, like voriconazole and ravuconazol, were also ineffective against biofilms. 52, 78, 79, 80 and 81 The intrinsic resistance of Candida species biofilms to fluconazole, an agent commonly used for antifungal treatment due to greater resistance to amphotericin B, has been reported. 81 However, therapeutic levels of echinocandins may inhibit the metabolic activities in C.