Clinical isolates of M. pachydermatis with reduced miconazole susceptibility were easily found, suggesting that miconazole resistance is present in routine patients. Lanosterol 14α-demethylase interactions with longer-tailed azoles involve additional contacts beyond A302 suggesting these drugs will be more effective against miconazole-resistant strains. However, effective antifungal stewardship is needed to slow development of pan-azole resistance that would limit treatment options for dogs with M. pachydermatis-associated disease.
Belcher et al. (Thu,) studied this question.