Treatment of disseminated and progressive cavitary histoplasmosis with ketoconazole

Ten patients with disseminated histoplasmosis and seven with progressive cavitary histoplasmosis were treated with ketoconazole, an imidazole derivative that is well absorbed orally and relatively nontoxic. Seven of seven noncompromised hosts with disseminated disease tolerated therapy well and achieved clinical and mycologic cures. Although well tolerated in all three compromised hosts with disseminated disease, none achieved clinical and bacteriologic cures. All patients with progressive cavitary disease tolerated therapy well and six of seven achieved clinical and radiographic cures. Therefore ketoconazole appears safe and effective in the treatment of disseminated or progressive cavitary histoplasmosis in the noncompromised host. In the compromised host with disseminated histoplasmosis, ketoconazole does not appear to be effective and more conventional therapy appears warranted.