Endemic mycoses: A treatment update

Olivier Lortholary, David W. Denning, Bertrand Dupont

Research output: Contribution to journalReview articlepeer-review

Abstract

Endemic mycoses remain a major public health problem in several countries and they are becoming increasingly frequent with the spread of HIV infection. Amphotericin B remains the drug of choice during the acute stage of life-threatening endemic mycoses occurring in both immunocompetent and immunocompromised hosts. Ketoconazole is effective in non-AIDS patients with non-life-threatening histoplasmosis, blastomycosis, or paracoccidioidomycosis. Itraconazole is the treatment of choice for non-life-threatening Histoplasma capsulatum or Blastomyces dermatitidis infections occurring in immunocompetent individuals and is the most efficient secondary prophylaxis of histoplasmosis in AIDS patients. Itraconazole is also effective in lymphocutaneous and visceral sporotrichosis, in paracoccidioidomycosis, for Penicillum marneffei infection, and is an alternative to amphotericin B for Histoplasma duboisii infection. Coccidioidomycosis may be effectively treated with prolonged and sometimes lifelong itraconazole or fluconazole therapy. Fluconazole has relatively poor efficacy against histoplasmosis, blastomycosis and sporotrichosis. New antifungal agents have been tested in vitro or in animal models and may soon be evaluated in clinical trials.

Original languageEnglish
Pages (from-to)321-331
Number of pages11
JournalJournal of Antimicrobial Chemotherapy
Volume43
Issue number3
Publication statusPublished - 19 Mar 1999

Keywords

  • acquired immunodeficiency syndrome
  • Amphotericin B
  • Antifungal agents
  • blastomycosis
  • coccidioidomycosis
  • mycoses
  • histoplasmosis

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