Antifungal activity of miltefosine against both azole-susceptible and resistant Aspergillus strains.

Miltefosine, an alkylphosphocholine, is the most recent drug approved to treat visceral leishmaniasis. Miltefosine has shown promise as a treatment for Paracoccidioidomycosis, and it has mixed activity against other fungi and yeast. There is limited data on miltefosine's in vitro activity against azole-resistant and susceptible Aspergillus species. The purpose of this study is to determine Miltefosine's in vitro activity against Aspergillus strains. Miltefosine was tested against 108 azole-susceptible and resistant Aspergillus strains isolated from Iran and other countries using the broth microdilution method. Miltefosine was found to be effective against azole-resistant Aspergillus isolates, with a MIC range of 1.562-6.25 µg/ml. The MIC and MIC concentrations were 1.562 and 3.125 µg/ml, respectively. Miltefosine, however, had a higher geometric mean MIC (2.459 µg/ml) for wild-type Aspergillus isolates than itraconazole (0.220 µg/ml) and voriconazole (0.298 µg/ml). There was no statistically significant difference in Miltefosine MIC results between azole-resistant Aspergillus isolates and azole-susceptible Aspergillus isolates (p-value >0.05). Miltefosine appears to have good in vitro activity against azole-resistant Aspergillus strains, according to these findings. Furthermore, the findings suggest that this agent could be used to treat infections caused by azole-resistant Aspergillus species.