Medical management of mycetoma

A number of drugs and drug combinations were tested both in vitro and in vivo against pathogens causing actinomycetoma and maduromycetoma. Of 144 patients with actinomycetoma treated, 63.2% were cured, 21.5% showed great improvement in their condition, and 11.1% showed some improvement. Treatment was successful even when there was advanced bone involvement. The most effective treatments involved dapsone plus streptomycin sulfate or sulfamethoxazole-trimethoprim plus streptomycin. Sulfadoxine-pyrimethamine plus streptomycin or rifampicin plus streptomycin also gave good results. Griseofulvin plus penicillin showed some promise in the management of maduromycetoma caused by Madurella mycetomi but at the present time this should be used only as an adjunct to surgery. All mycetoma patients undergoing drug therapy should be carefully monitored and treatment should be temporarily suspended if anaemia or leucopenia develop.