A Pan-American 5-Year Study of Fluconazole Therapy for Deep Mycoses in the Immunocompetent Host
Diaz, Manuel; Negroni, Ricardo; Montero-Gei, Fernando; Castro, Luiz G. M.; Sampaio, Sebastiao A. P.; Borelli, Dante; Restrepo, Angela; Franco, Liliana; Bran, Jose L.; Arathoon, Eduardo G.; Stevens, David A.; From the Universidad Autonoma de Nuevo Leon, Hospital Universitario, Monterrey, Mexico; Facultad de Medicina, Buenos Aires, Argentina; Hospital San Juan de Dios, San Jose, Costa Rica; Departamento de Dermatologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil; Universidad Central de Venezuela, Caracas, Venezuela; Corporacion para Investigaciones Biologicas, Hospital Pablo Tobon Uribe, Medellin, Colombia; Universidad San Carlos, Guatemala City, Guatemala; and Santa Clara Valley Medical Center, Stanford University Medical School, San Jose, California
Журнал:
Clinical Infectious Diseases
Дата:
1992
Аннотация:
Eighty-eight immunocompetent patients with deep mycoses from eight countries were evaluated with the same protocol for efficacy of fluconazole monotherapy. Entry doses were raised from 100 to 400 mg as safety was shown in initial cohorts, and dosages up to 2,400 mg daily and durations up to 44 months were studied. Results were very similar in different countries. Twenty-seven of 28 evaluable patients with paracoccidioidomycosis, 13 of 19 with sporotrichosis, 14 of 16 with coccidioidomycosis, and eight of eight with histoplasmosis demonstrated objective responses to therapy, as did one patient each with zygomycosis and alternariosis. For these patients, relapses have been unusual thus far. In contrast, one patient with chromoblastomycosis responded but relapsed, and six did not respond; one patient with mycetoma responded but relapsed, and two did not respond. The drug was well tolerated by patients, including six who received intravenous therapy. In vitro susceptibility tests suggested that clinical response was correlated with susceptibility but that resistance did not preclude clinical response. Fluconazole therapy appears efficacious for several deep mycoses; dosages of >200 mg daily may be needed for some diseases. The further evaluation of fluconazole for these entities is warranted.
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