Pulmonary sporotrichosis: Treatment with miconazole

Intravenous miconazole, an investigational, broad-spectrum, antifungal imidazole drug, was clinically effective when used for the first time in a patient with life-threatening sporotrichosis. Miconazole was used after drug resistance and treatment failure occurred in a patient with extensive, cavitary, pulmonary infection with Sporotrichum schenckii. He had first been treated with amphotericin B, and then with amphotericin B and flucytosine in combination. Side effects of miconazole included itching, diarrhea, and phlebitis. Clinical improvement occurred despite plasma concentrations below those needed for complete inhibition of the patient's organisms in vitro.