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Therapeutic failures with miconazole.

J F Fisher, R J Duma, S M Markowitz

    Antimicrobial Agents and Chemotherapy
    |June 1, 1978
    PubMed
    Summary
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    Miconazole failed to treat deep fungal infections in three patients despite in vitro susceptibility. Suboptimal body fluid levels, potentially due to poor tissue penetration or rapid excretion, likely caused therapeutic failure.

    Area of Science:

    • Mycology
    • Pharmacology
    • Infectious Diseases

    Background:

    • Miconazole is a broad-spectrum imidazole antifungal agent.
    • It is reportedly effective via topical, oral, and parenteral administration.
    • This study reviews therapeutic failures in patients with deep fungal infections.

    Observation:

    • Three patients with deep fungal infections (Sporothrix schenckii arthritis, Cryptococcus neoformans meningoencephalitis, Aspergillus fumigatus disseminated aspergillosis) were treated with intravenous miconazole.
    • All causative fungi were susceptible to miconazole in vitro.
    • Despite high doses, miconazole failed to control infections, with low serum and undetectable cerebrospinal fluid levels.

    Findings:

    • Therapeutic failure was attributed to suboptimal miconazole body fluid levels.

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  • Potential reasons include poor tissue penetration, in vitro inactivation, or rapid excretion.
  • Adverse effects included fever, chills, nausea, vomiting, and phlebitis.

    • Implications:

    • Miconazole's efficacy in deep-seated mycoses may be limited by pharmacokinetic factors.
    • Further research is needed to understand the reasons for low drug levels.
    • Clinical use of miconazole for severe fungal infections requires careful consideration of potential therapeutic failure.