Ketoconazole in Fungal Infections Refractory oral candidiasis clears rapidly but relapse rates are high ...

In an open tnal, 12 pat1ents with at least a 6-month history of chronic recalcitrant mucocutaneous candidiasis were g1ven ketoconazole 200mg daily until symptoms resolved. All had oral mfect1ons and most had fingernail mvolvement.

The pat1ents were assessed every 4 weeks until cl1nical clearance and thereafter every 2-3 months for 3 years. Only 2 patients remamed d1sease-free after treatment ended with the remainder having an average symptom-free 1nterval of 55 months. All 12 patients reported an improved oral condition after only a few days w1th cl1nical clearance tak1ng an average of 1-2 months. However. the fingernail les1ons took between 4 and 14 months to heal completely. One patient developed an increase in hepatic enzymes with levels returning to normal within 4 weeks of drug removal but side effects were not otherwise a problem

This study has shown that 'dramatic clinical improvements occur ... ' however, because of the possibil1ty of drug toxicity 'it is thus essential that ketoconazo/e patients are fully supervised'. Mobacken H Moberg S Dermatolog1ca 173 229-236. Nov 1986

... and a gradual clinical improvement is seen in patients with pulmonary aspergillosis In a double-blind randomised study, 10 patients w1th allerg1c bronchopulmonary aspergillosis and

mycetoma received ketoconazole 400mg or placebo daily for one year. A 40% reduct1on m lgG antibody to Aspergillus fumtgatus was seen after 3 months' ketoconazole

treatment (p < 0.05). which was Significantly correlated w1th a gradual reduction 1n symptom scores after 6 months 1n the ketoconazole group. No new pulmonary infiltrates were seen in either group No effect of treatment on FEV 1 and FVC was seen. Patients receiving ketoconazole uniformly reported benefit from treatment, and no adverse effects were noted.

Thus, ketoconazole treatmeent has shown some benefit. and ' ... further studies of its use in allergic bronchopulmonary aspergillosis may be warranted'. Shale DJ Faux JA Lane OJ Thorax 42 26 31 Jan 1987

0156-2703/87/0307-()()()9!0$01.00/0 © ADIS Press INPHARMA' 7 Mar 1987 9