Treatment of oral candidosis with itraconazole: a review.

Oral candidosis is a common infection in infants, elderly persons, patients receiving immunosuppressive therapy, and patients with acquired immunodeficiency syndrome (AIDS). The orally active antifungal agent itraconazole has been evaluated in a number of different patient populations with oral and oropharyngeal candidosis. Initial studies have shown that itraconazole, 100 or 200 mg/day for 14 days, is more active than placebo in treating oral candidosis. A comparative study between itraconazole capsules (200 mg once daily) and clotrimazole troches (10 mg five times daily) showed equivalent results at the end of therapy but a significantly faster response to itraconazole and a faster relapse rate with clotrimazole. A study in AIDS patients with oropharyngeal candidosis demonstrated that itraconazole, 200 mg/day, and ketoconazole, 400 mg day, for 4 weeks give equivalent clinical cure rates and similar relapse rates. A pilot study with an oral solution of itraconazole has given an impressive 100% clinical and mycological response rate within 1 week of treatment. In conclusion, itraconazole in capsule or in solution form may constitute a major addition to the armamentarium of drugs against oropharyngeal candidosis.

Ketoconazole in the treatment of blepharitis.

A double masked, placebo controlled clinical trial, of topical 2% ketoconazole cream with lid hygiene, for the treatment of seborrhoeic and mixed seborrhoeic/staphylococcal blepharitis was conducted. Forty patients with symptomatic blepharitis, 20 randomly allocated to ketoconazole, 20 to placebo were entered. Treatment efficacy was assessed by improvement of symptoms using visual analogue scales, appearance of the eyelids and reduction in numbers of pityrosporum yeasts on the eyelids. Both groups showed a similar reduction in symptoms, and signs of inflammation. The overall clinical impression in the ketoconazole group was better at week five than in the placebo group. Sixty nine per cent were either normal or markedly improved, as compared to 42% in the placebo group, although this was not statistically significant (p less than 0.1, one-sided Mann-Whitney). Pityrosporum numbers were reduced significantly in both groups during the treatment period. Ketoconazole was no better than placebo at improving the symptoms of blepharitis. More ketoconazole treated patients had normal or markedly improved lids after treatment than the placebo group. Pityrosporum yeasts may play a role in blepharitis, and treatment with an antifungal has some advantages over conventional therapy.

Systemic absorption of ketoconazole from vaginal pessaries.

Eight healthy female subjects were each given (a) ketoconazole 400 mg orally, (b) ketoconazole 400 mg as a single vaginal pessary, (c) ketoconazole 800 mg as two vaginal pessaries, and (d) ketoconazole 1200 mg as three vaginal pessaries. The area under the plasma concentration time curve (AUC) after the oral dose was 51.41 +/- 10.99 mg l-1 h (mean +/- s.d.) and the half-life of ketoconazole was 2.98 +/- 1.41 h. The AUCs after vaginal administration were 0.27 +/- 0.14, 0.52 +/- 0.25, and 0.43 +/- 0.22 mg-1 l h following the 400, 800 and 1200 mg pessaries respectively. Systemic absorption of single doses of vaginally administered ketoconazole appears to be negligible in the absence of vaginal infection. There were no local or systemic side effects related to ketoconazole in these healthy volunteers.

Bacteria and fungi in severe foot infection.

In a study of severe foot infection in 21 miners, an attempt was made to match nine clinical parameters with both bacteriological and mycological findings. Erythema was significantly more pronounced in the presence of dermatophytes but less pronounced in the presence of Gram-negative bacilli. No other clinical parameter differed in relation to the presence of particular microorganisms.