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Newer developments in therapy for endemic mycoses

C A Kauffman1

  • 1Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|August 1, 1994
PubMed
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The triazole era, marked by itraconazole, revolutionized endemic fungal infection treatment. Itraconazole offers effective oral therapy for histoplasmosis, blastomycosis, and potentially sporotrichosis, improving outpatient care.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Pharmacology

Background:

  • Amphotericin B was the sole effective treatment for serious endemic fungal infections in the mid-20th century.
  • Ketoconazole's introduction in the 1980s enabled oral, outpatient treatment for some endemic mycoses.
  • The 1990s ushered in the triazole era, significantly advancing antifungal therapy.

Purpose of the Study:

  • To review the evolution of antifungal therapies for endemic mycoses.
  • To highlight the role of itraconazole in treating histoplasmosis, blastomycosis, and sporotrichosis.
  • To emphasize the shift towards oral, outpatient treatment regimens.

Main Methods:

  • Literature review of antifungal treatments for endemic fungal infections.
  • Analysis of historical treatment trends from the 1960s to the 1990s.

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  • Evaluation of itraconazole's efficacy in various endemic mycoses.

    • Main Results:

    • Itraconazole is now the drug of choice for nonmeningeal, non-life-threatening histoplasmosis and blastomycosis, enabling oral outpatient treatment.
    • Itraconazole has demonstrated efficacy in treating histoplasmosis, including in patients with human immunodeficiency virus.
    • Preliminary studies indicate itraconazole is effective for various forms of sporotrichosis, including disseminated infections.

    Conclusions:

    • The triazole era, particularly with itraconazole, has transformed the management of endemic fungal infections.
    • Itraconazole provides a crucial oral therapeutic option for histoplasmosis and blastomycosis, enhancing patient care.
    • Further research supports itraconazole's potential as a treatment for sporotrichosis, expanding its clinical utility.