Itraconazole for the treatment of histoplasmosis and blastomycosis

Itraconazole is a triazole compound with broad-spectrum antifungal activity which includes the pathogenic yeasts, certain Aspergillus species, and the endemic fungi such as Histoplasma capsulatum and Blastomycosis dermatitidis. Although prospective trials comparing itraconazole to other azoles and amphotericin B are unavailable, recently published data suggest that itraconazole is the drug of choice for patients with mild to moderate histoplasmosis and blastomycosis without central nervous system involvement. Among patients with the acquired immunodeficiency syndrome and histoplasmosis, itraconazole has emerged as an effective alternative to amphotericin B for induction therapy in selected patients, and has largely replaced amphotericin B for chronic maintenance therapy in these patients. For patients with severe or life-threatening histoplasmosis or blastomycosis and for patients with central nervous system involvement, amphotericin B remains the initial therapy of choice.