Journal of Antimicrobial Chemotherapy (1999) 43, 321-331
© 1999 The British Society for Antimicrobial Chemotherapy
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Endemic mycoses: a treatment update
a Service de Médecine Interne, Centre de Recherche en Pathologie Infectieuse et Tropicale, Hôpital Avicenne, Université Paris Nord, 125 route de Stalingrad, 93009 Bobigny, France b Department of Infectious Diseases and Tropical Medicine (Monsall Unit), North Manchester General Hospital, Delaunays Road, University of Manchester, Manchester M8 6RB, UK c Unité de Mycologie et Centre National de Référence des Mycoses et des Antifongiques, Institut Pasteur, 25 rue du Dr Roux, 75724 Paris Cedex 15, France
Endemic mycoses remain a major public health problem in several countries and they are becoming increasingly frequent with the spread of HIV infection. Amphotericin B remains the drug of choice during the acute stage of life-threatening endemic mycoses occurring in both immunocompetent and immunocompromised hosts. Ketoconazole is effective in non-AIDS patients with non-life-threatening histoplasmosis, blastomycosis, or paracoccidioidomycosis. Itraconazole is the treatment of choice for non-life-threatening Histoplasma capsulatum or Blastomyces dermatitidis infections occurring in immunocompetent individuals and is the most efficient secondary prophylaxis of histoplasmosis in AIDS patients. Itraconazole is also effective in lymphocutaneous and visceral sporotrichosis, in paracoccidioidomycosis, for Penicillum marneffei infection, and is an alternative to amphotericin B for Histoplasma duboisii infection. Coccidioidomycosis may be effectively treated with prolonged and sometimes lifelong itraconazole or fluconazole therapy. Fluconazole has relatively poor efficacy against histoplasmosis, blastomycosis and sporotrichosis. New antifungal agents have been tested in vitro or in animal models and may soon be evaluated in clinical trials.
* Corresponding address. Unité de Mucologie et Centre National De Références des Mycoses et des Antifongiques, Institut Pasteur, 25 rue du Dr Rous, 75724 Paris Cedex 15, France. Tel:+33-1-45-68-83-54; Fax+33-1-45-68-84-20; E-mail: olortho{at}pasteur.fr
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