, Volume 72, Issue 1, pp 35–45 | Cite as

Ketoconazole in Paracoccidioidomycosis: Efficacy of prolonged oral therapy

  • A. Restrepo
  • D. A. Stevens
  • E. Leiderman
  • J. Fuentes
  • A. Arana
  • R. Angel
  • G. Mejía
  • I. Gómez


Ketoconazole, a new oral imidazole derivative, was employed for the treatment of five patients with paracoccidioidomycosis. The response was excellent, with objective clinical improvement and healing of both mucocutaneous and pulmonary lesions. Mycological and serological tests, as well as delayed hypersensitivity, were assessed and found to correlate with clinical improvement. Therapy was conducted for 12 months with a dose of 200 mg day in 2 patients; in the remainder the dose was reduced (100 mg day) after the first 6 months and maintained as such for an equal period. No side-effects or toxicity were noted despite prolonged treatment. The advantages of the new therapeutic approach are discussed.


Toxicity Imidazole Therapeutic Approach Clinical Improvement Ketoconazole 
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Un nuevo derivado del imidazole para uso oral, ketoconazole, fué empleado en el tratamiento de 5 pacientes con paracoccidioidomicosis. Se condujo la terapia por un año, con base a la administración de una pastilla (200 mg) por día en 2 pacientes; en los 3 restantes, esta dosis fué reducida a la mitad y mantenida en tal nivel por otros 6 meses. La respuesta fué excelente con mejoría clínica objetiva y cicatrización de las lesiones tegumentarias y pulmonares. Los estudios micológicos y serológicos, a la par que la sensibilidad cutanea, llevados a cabo durante el curso del tratamiento indicaron también mejoría. No se anotó ninguna toxicidad para la droga ni los pacientes experimentaron efectos secundarios. Las ventajas de esta nueva clase de terapia son discutidas en el texto.


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  1. 1.
    Bennett, J.E. 1974. Chemotherapy of systemic mycoses. New England J. Med. 290: 320–322.Google Scholar
  2. 2.
    Borelli, D. 1972. Administration de la anfotericina. Mycopath. Myc. Appl. 46: 233–236.Google Scholar
  3. 3.
    Borelli, D. 1975. Tratamiento de las micosis. Gaceta Médica, Caracas. 83: 181–188.Google Scholar
  4. 4.
    Borelli, D., J.L. Bran, J. Fuentes, R. Legendre, E. Leiderman, H.B. Levine, A. Restrepo & D.A. Stevens. 1979. Ketoconazole, an oral antifungal: laboratory and clinical assesment of imidazole drugs. Postgrad. Med. J. 55: 657–661.Google Scholar
  5. 5.
    Dixon, D., S. Shadomy, H.J. Shadomy, A. Espinel-Ingroff & T.M. Keikering. 1978. Comparison of the in vitro antifungal activities of miconazole and a new imidazole, R-41400. J. Infect. Dis. 138: 245–248.Google Scholar
  6. 6.
    Galgiani, J.N. & D.A. Stevens. 1976. Antimicrobial sensitivity testing of yeasts: a turbidimetric technique independent of inoculum size. Antimicrob. Agents Chemother. 11: 721–726.Google Scholar
  7. 7.
    Kaufman, L., M. Huppert, C. Fava Netto, L. Pollak, R. Negroni & A. Restrepo. 1972. Manual of standardized serodiagnostic procedures for systemic mycoses. Part I. Agar gel immunodiffusion tests. Panamerican Health Organization, Washington, D.C.Google Scholar
  8. 8.
    Kaufman, L., M. Huppert, C. Fava Netto, L. Pollak, R. Negroni & A. Restrepo. 1974. Manual of standardized serodiagnostic procedures for systemic mycoses. Part II. Complement fixation tests. Pan American Health Organization, Washington, D.C.Google Scholar
  9. 9.
    Levine, H.B. & J.M. Cobb. 1978. Oral therapy for experimental coccidioidomycosis with R-41400 (ketoconazole), a new imidazole. Am. Rev. Resp. Dis. 118: 715–721.Google Scholar
  10. 10.
    Lima, N.S., S. Texeira, J. Miranda & A.C.F. Valle. 1978. Treatment of South American Blastomycosis (paracoccidioidomycosis) with orally administered miconazole. Rev. Inst. Med. Trop. Sao Paulo 20: 347–352.Google Scholar
  11. 11.
    McClure, E., L. Pals & C. Lemos. 1959. Alteraçoes pulmonares na micose de Lutz apos tratamento pela sulfa. Hospital (Rio) 56: 741–746.Google Scholar
  12. 12.
    Negro, G. 1975. Tratamento do paracoccidioidomicose. Ars. Curandi (Rev. Terap. Med. Brasil). 7: 38–44.Google Scholar
  13. 13.
    Negroni, P. 1972. Prolonged therapy for paracoccidioidomycosis. Approaches, complications and risks. Proc. Panam. Symp. Paracoccidioidomycosis, PAHO Scient. Publ. 254, Washington, D.C. pp. 147–152.Google Scholar
  14. 14.
    Negroni, R., P. Rubinstein, A. Hermann, A. Gimenez. 1977. Results of miconazole therapy in 28 patients with paracoccidioidomycosis. Proc. Royal Soc. Med. 70 (Suppl. 1): 24–28.Google Scholar
  15. 15.
    Restrepo, A. & J.D. Schneidau. 1967. Nature of the skin test reactive principle in culture filtrates prepared from P. brasiliensis. J. Bact. 93: 1741–1748.Google Scholar
  16. 16.
    Restrepo, A. & L.H. Moncada. 1970. Serological reactions in paracoccidioidomycosis. Proc. Internat. Symp. Mycoses. Pan American Health Organization, Washington, Scient. Publ. No. 205, pp. 101–111.Google Scholar
  17. 17.
    Restrepo, A., M. Restrepo, F. Restrepo, L. Aristizábal, L.H. Moncada & H. Vélez. 1978. Immune responses in paracoccidioidomycosis. A controlled study of 16 patients before and after treatment. Sabouraudia 16: 151–163.Google Scholar
  18. 18.
    Restrepo, A. 1978. Actualización sobre paracoccidioidomicosis. Acta Med. Colombiana. 3: 33–65.Google Scholar
  19. 19.
    Rodríguez, H. & D. Borelli. 1976. Miconazole per os en tiña y micosis profundas. Medicina Cutánea I.L.A. 3: 199–204.Google Scholar
  20. 20.
    Stevens, D.A. 1977. Miconazole in the treatment of systemic fungal infections. Am. Rev. Resp. Dis. 116: 801–806.Google Scholar
  21. 21.
    Stevens, D.A., A. Restrepo, A. Cortés, J. Betancourt, J.N. Galgiani, & I. Gómez. 1978. Paracoccidioidomycosis (South America Blastomycosis). Treatment with miconazole. Am. J. Trop. Med. Hyg. 27: 801–807.Google Scholar

Copyright information

© Dr. W. Junk B.V. Publishers 1980

Authors and Affiliations

  • A. Restrepo
    • 1
  • D. A. Stevens
    • 2
  • E. Leiderman
    • 3
  • J. Fuentes
    • 4
  • A. Arana
    • 4
  • R. Angel
    • 3
  • G. Mejía
    • 1
  • I. Gómez
    • 1
  1. 1.Corporacion de Investigaciones Biológicas (CIB) and Hospital Pablo Tobón UribeMedellínColombia
  2. 2.Division of Infectious Diseases, Santa Clara Valley Medical CenterStanford UniversitySan JoséUSA
  3. 3.Departamento de Medicina InternaInstituto de los Seguros SocialesMedellínColombia
  4. 4.Hospital La MaríaMedellínColombia

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