ABSTRACT
OBJETIVO: Avaliar e comparar a eficácia dos antifúngicos tópicos empregados no tratamento de cada dermatomicose. MÉTODOS: Foi desenvolvida uma revisão sistemática de ensaios clínicos randomizados, publicados em português, espanhol ou inglês até julho de 2010, que comparassem o uso de antifúngicos azólicos e alilamínicos entre si ou com placebo, no tratamento de candidíase cutânea, e das tineas versicolor, pedis, cruris e corporis. Os desfechos de eficácia avaliados foram cura micológica ao final do tratamento e cura sustentada. RESULTADOS: Dos 4.424 estudos inicialmente identificados, 49 alcançaram os critérios de seleção, sendo incluídos nas metanálises. Os dados agrupados de eficácia demonstraram superioridade dos antifúngicos frente a placebo, independente da dermatomicose avaliada, com valores de odds ratio (OR) variando de 2,05 (IC 95% 1,18-3,54) a 67,53 (IC 95% 11,43-398,86). Alilaminas foram superiores aos azólicos apenas para o desfecho cura sustentada (OR 0,52 [IC 95% 0,31-0,89]). CONCLUSÃO: Há evidência consistente da superioridade dos antifúngicos com relação ao uso de placebo, não sendo mais justificável a realização de estudos controlados por placebo. Alilaminas mantêm a cura micológica por períodos mais extensos que fármacos azólicos. Dada a significativa diferença de custo entre as classes, recomenda-se a realização de análises farmacoeconômicas.
OBJECTIVE: To evaluate and compare the efficacy of topical antifungal drugs applied to the treatment of each dermatomycosis. METHODS: A systematic review of randomized clinical trials, published in Portuguese, Spanish and English until July 2010, which compared the use of azole and allylamine antifungal drugs among themselves and with placebo in the treatment of cutaneous candidiasis and T. versicolor, T. pedis, T. cruris and T. corporis was performed. The efficacy outcomes evaluated were mycological cure at the end of treatment and sustained cure. RESULTS: Of the 4,424 studies initially identified, 49 met the selection criteria and were included in the meta-analyses. The grouped efficacy data evidenced the superiority of antifungal drugs compared to placebo, regardless of the dermatomycosis under evaluation, with odds ratio values ranging from 2.05 (95% CI 1.18-3.54) to 67.53 (95% CI 11.43-398.86). Allylamines were better than azoles only for the outcome sustained cure (OR 0.52 [95% CI 0.31-0.89]). CONCLUSION: There is consistent evidence of the superiority of antifungal drugs over the use of placebo, and placebo-controlled studies are no longer justifiable. Allylamines maintain the mycological cure for longer periods compared to azole drugs. Given the significant cost difference among the classes, pharmacoeconomic analyses should be performed.
Subject(s)
Humans , Antifungal Agents/administration & dosage , Candidiasis, Cutaneous/drug therapy , Tinea/drug therapy , Administration, Cutaneous , Randomized Controlled Trials as Topic , Treatment OutcomeABSTRACT
Forty-three proven cases of fungus infection of the cornea have been studied in the Philippine Eye Research Institute since 1968. Clinical features that suggested the nature of the infection included the (a) history of previous ocular trauma due to some vegetable matter, (b) severity of the pain on the affected eye, (c) non-response to prolonged anti-bacterial therapy, (d) preponderance of hard ulcers indicating minimal tissue necrosis, and the (e) hypopyon, when present, tended to be stringy and well-adherent to the back surface of the corneaEtiologic diagnosis requires demonstration of the organism in smears, cultures or preferably in the biopsy specimens. For this purpose, it is advised that the specimens should include portions of the advancing borders of the lesionsFusarium and Aspergillus which are plant pathogens were the most common fungi isolated from the cases. Others included Mycelia sterila, Hormodendrum, Curvularia, Phialophora verrucosa, Cephalosporium, Paecilomyces and Candida kruseiMedical therapy of the infection was not very encouraging. Part of the reason is that while the antifungal drugs are effective in-vitro against a wide variety of fungal cultures, they poorly penetrate the cornea. Surgical excision of the lesion removed a bulk of the infecting organisms and when used in conjunction with the antimycotic drugs, the procedure helped control the infection. (Summary)