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Original article| Volume 18, ISSUE 2, P161-165, March 1989

Experience with itraconazole in cryptococcosis and aspergillosis

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      Summary

      Cryptococcosis and aspergillosis in immunocompromised patients are extremely difficult clinical conditions to manage and treatment with available antifungal drugs often fails. Itraconazole, R-51211, Janssen Pharmaceutica, a new orally absorbed triazole, is a possible alternative drug which is potentially effective and nontoxic. Preliminary experience with 28 patients, eight with cryptococcosis and 20 with aspergillosis, is reported. Of these patients, 16 were immunocompromised (seven with the acquired immune-deficiency syndrome (AIDS), five heart transplant recipients and four with leukaemia or lymphoma). Overall, results of treatment were good (18 in remission, four markedly improved, four moderately improved and two failed). Prevention of relapses of cryptococcosis was obtained in all patients with AIDS on long-term itraconazole monotherapy (3 mg/kg). Treatment of invasive aspergillosis required a higher dosage (about 5 mg/kg) and prolonged administration. Besides its efficacy this antifungal agent allowed outpatient management.
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      References

        • Fraser DW
        • Waral JI
        • Ajello L
        • Plikaytis BD
        Aspergillosis and other systemic mycoses.
        JAMA. 1979; 242: 1631-1635
        • Fisher BD
        • Armstrong D
        • Yu B
        • Gold JWM
        Invasive aspergillosis.
        in: Progress in early diagnosis and treatment. Am J Med. 71. 1981: 571-577
        • Baumgartner WA
        Infection in cardiac transplantation.
        J Heart Transplant. 1983; 3: 75-90
      1. (Abstract 804)
        • Kovacs JA
        • Polis M
        • Macher AM
        • et al.
        Cryptococcus infections in patients with the acquired immunodeficiency syndrome.
        in: 24th Interscience conference on antimicrobial agents and chemotherapy. American Society for Microbiology, London1984
        • Zuger A
        • Louie E
        • Holzman RS
        • Simberkoff MS
        • Rahal JJ
        Cryptococcal disease in patients with the acquired immunodeficiency syndrome.
        in: Diagnostic features and outcome of treatment. Ann Intern Med. 104. 1986: 234-240
        • Vancutsem J
        • Janssen PAJ
        Nouveaux antimycosiques: Activité in vitro et in vivo.
        Bull Soc Fr Mycol Méd. 1985; 14: 131-140
      2. Basic medical information brochure. Janssen Pharmaceutica, Washington, DC1986 (5th ed.)
        • Viviani MA
        • Tortorano AM
        • Woestenborghs R
        • Cauwenbergh G
        Experience with itraconazole in deep mycoses in Northern Italy.
        Mykosen. 1987; 30: 233-244
        • Dorn GL
        • Smith K
        New centrifugation blood culture device.
        J Clin Microbiol. 1978; 7: 52-54
        • Viviani MA
        • Tortorano AM
        Milieu sélectif pour l'isolement de Cryptococcus neoformans des expectoration à flore levuriforme mixte.
        Bull Soc Fr Mycol Méd. 1974; 3: 189-194
        • Shadomy S
        • Kirchoff CB
        • Ingroff AE
        In vitro activity of 5-fluoro cytosine against Candida and Torulopsis species.
        Antimicrob Agents Chemother. 1973; 3: 9-14
        • Hay RJ
        The spectrum of pulmonary disease caused by aspergilli.
        in: Proceedings of the 2nd symposium on topics in mycology: Aspergillus and aspergillosis. Janssen Pharmaceutica, Beerse, Belgium1987: 62
        • Gallucci V
        • Mazzucco A
        • Faggian G
        • et al.
        Orthotopic heart transplantation: Initial clinical experience at the University of Padova.
        J Heart Transplant. 1986; 5: 50-51
        • Parenzan L
        • Ferrazzi P
        • Fiocchi R
        • Mamprin F
        Trapianto cardiaco a Bergamo: 7 mesi di esperienza.
        Arch Chirurgia Toracica. 1986; 8: 3-4
        • Woestenborghs R
        • Lorreyne W
        • Heykants J
        Determination of itraconazole in plasma and in animal tissue by high-performance liquid chromatography.
        J Chromatogr Biomed Appl. 1987; 413: 332-337
        • Perfect JR
        • Savani DV
        • Durack DT
        Comparison of itraconazole and fluconazole in treatment of cryptococcal meningitis and candida pyelonephritis in rabbits.
        Antimicrob Agents Chemother. 1986; 29: 579-583
        • Vancutsem J
        • Janssen PAJ
        La cryptococcose expérimentale et son traitement.
        in: Dermatotropisme de Cryptococcus neoformans. Bull Soc Fr Mycol Méd. 15. 1986: 31-44
        • Phillips P
        • Fetchick R
        • Weisman I
        • Foshee S
        • Graybill JR
        Tolerance to and efficacy of itraconazole in treatment of systemic mycoses: Preliminary results.
        Rev Infect Dis. 1987; 9: S87-S93
        • Restrepo A
        • Munera MI
        • Arteaga ID
        • Gomez I
        • Tabares AM
        • Arango M
        Developments in the treatment of aspergilloma.
        in: Proceedings of the 2nd Symposium on topics in mycology: Aspergillus and aspergillosis. Janssen Pharmaceutica, Antwerp1987: 99-101
        • Kwan JTC
        • Foxall PJD
        • Davidson DGC
        • Bending MR
        • Eisinger AJ
        Interaction of cyclosporin and itraconazole.
        Lancet. 1987; ii: 282
        • Trenk D
        • Brett W
        • Jähnchen E
        • Birnbaum D
        Time course of cyclosporin/itraconazole interaction.
        Lancet. 1987; ii: 1335-1336