ITRACONAZOLE THERAPY FOR BLASTOMYCOSIS AND HISTOPLASMOSIS

被引:210
作者
DISMUKES, WE
BRADSHER, RW
CLOUD, GC
KAUFFMAN, CA
CHAPMAN, SW
GEORGE, RB
STEVENS, DA
GIRARD, WM
SAAG, MS
BOWLESPATTON, C
机构
[1] UNIV ALABAMA, CTR COMPREHENS CANC, BIOSTAT UNIT, BIRMINGHAM, AL 35294 USA
[2] UNIV ARKANSAS MED SCI HOSP, DIV INFECT DIS, LITTLE ROCK, AR 72205 USA
[3] VET AFFAIRS MED CTR, INFECT DIS SECT, ANN ARBOR, MI USA
[4] UNIV MISSISSIPPI, MED CTR, DIV INFECT DIS, JACKSON, MS 39216 USA
[5] LOUISIANA STATE UNIV, SCH MED, DIV PULM & CRIT MED, SHREVEPORT, LA 71105 USA
[6] SANTA CLARA VALLEY MED CTR, DIV INFECT DIS, SAN JOSE, CA 95128 USA
[7] UNIV TEXAS, DIV PULM DIS, TYLER, TX USA
关键词
D O I
10.1016/0002-9343(92)90575-V
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE: To assess the efficacy and toxicity of orally administered itraconazole in the treatment of nonmeningeal, nonlife-threatening forms of blastomycosis and histoplasmosis. DESIGN: Prospective, nonrandomized, open trial. SETTING: Multicenter trial at 14 university referral centers. PATIENTS: Eighty-five patients with culture or histopathologic evidence of blastomycosis (48 patients) or histoplasmosis (37 patients). Patients receiving other systemic antifungal therapy were excluded. INTERVENTIONS: Itraconazole was administered orally at doses of 200 to 400 mg/d. Patients in whom treatment was considered a success were treated for a median duration of 6.2 months (blastomycosis) and 9.0 months (histoplasmosis). Disease activity was assessed at baseline; drug efficacy and toxicity were evaluated at monthly intervals during therapy, and efficacy was evaluated at regular follow-up visits after completion of therapy. The median duration of posttreatment evaluation for successfully treated patients was 11.9 months (blastomycosis) and 12.1 months (histoplasmosis). MEASUREMENTS AND MAIN RESULTS: Among the 48 patients with blastomycosis, success was documented in 43 (90%). The success rate for patients treated for more than 2 months was 95% (38 of 40). Among the 37 patients with histoplasmosis, success was documented in 30 (81%). The success rate for patients treated for more than 2 months was 86% (30 of 35). All patients with histoplasmosis in whom treatment failed had chronic cavitary pulmonary disease. Toxicity was minor, only 25 (29%) patients experienced any side effects, and itraconazole toxicity necessitated stopping therapy in only 1 patient. CONCLUSIONS: Itraconazole is a highly effective therapy for nonmeningeal, nonlife-threatening blastomycosis and histoplasmosis. The drug is associated with minimal toxicity.
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收藏
页码:489 / 497
页数:9
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