Potential Inhibitory Effect of Miltefosine against Terbinafine-Resistant Trichophyton indotineae




Haghani, Iman
Akhtari, Javad
Yahyazadeh, Zahra
Espahbodi, Amirreza
Kermani, Firoozeh
Javidnia, Javad
Hedayati, Mohammad Taghi
Shokohi, Tahereh
Badali, Hamid
Rezaei-Matehkolaei, Ali

Journal Title

Journal ISSN

Volume Title




Several prolonged and significant outbreaks of dermatophytosis caused by Trichophyton indotineae, a new emerging terbinafine-resistant species, have been ongoing in India in recent years, and have since spread to various countries outside Asia. Miltefosine, an alkylphosphocholine, is the most recently approved drug for the treatment of both visceral and cutaneous leishmaniasis. Miltefosine in vitro activity against terbinafine-resistant and susceptible T. mentagrophytes/T. interdigitale species complex, including T. indotineae, is limited. The current study aimed to assess miltefosine’s in vitro activity against dermatophyte isolates, which are the most common causes of dermatophytosis. Miltefosine, terbinafine, butenafine, tolnaftate, and itraconazole susceptibility testing was performed using Clinical and Laboratory Standards Institute broth microdilution methods (CLSI M38-A3) against 40 terbinafine-resistant T. indotineae isolates and 40 terbinafine-susceptible T. mentagrophytes/T. interdigitale species complex isolates. Miltefosine had MIC ranges of 0.063–0.5 µg/mL and 0.125–0.25 µg/mL against both terbinafine-resistant and susceptible isolates. In terbinafine-resistant isolates, the MIC50 and MIC90 were 0.125 µg/mL and 0.25 µg/mL, respectively, and 0.25 µg/mL in susceptible isolates. Miltefosine had statistically significant differences in MIC results when compared to other antifungal agents (p-value 0.05) in terbinafine-resistant strains. Accordingly, the findings suggest that miltefosine has a potential activity for treating infections caused by terbinafine-resistant T. indotineae. However, further studies are needed to determine how well this in vitro activity translates into in vivo efficacy.



miltefosine, T. mentagrophytes, T. interdigitale, T. indotineae, terbinafine, miltefosine, T. mentagrophytes, T. interdigitale, T. indotineae, terbinafine


Haghani, I., Akhtari, J., Yahyazadeh, Z., Espahbodi, A., Kermani, F., Javidnia, J., Hedayati, M. T., et al. (2023). Potential Inhibitory Effect of Miltefosine against Terbinafine-Resistant Trichophyton indotineae. Pathogens, 12(4), 606. MDPI AG. Retrieved from http://dx.doi.org/10.3390/pathogens12040606


Molecular Microbiology and Immunology