Mycoses
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Review Comparative Study
Antifungal prophylaxis with itraconazole oral solution in neutropenic patients.
The role of itraconazole in anti-fungal prophylaxis has been limited by the low bioavailability of the capsule formulation but the bioavailability of the oral solution is much improved. Three multi-centre studies using itraconazole solution (5 mg/kg/day) have recently been completed. The UK trial compared itraconazole solution with fluconazole suspension (100 mg/day). ⋯ Azole prophylaxis in neutropenic patients may reduce the incidence of Candida infections, empirical amphotericin B usage, and the incidence of proven fungal infections. Itraconazole may be more effective than fluconazole in preventing invasive aspergillosis. All of these effects are more pronounced in high risk patients.
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Breakthrough invasive fungal infections in neutropenic patients after prophylaxis with itraconazole.
This study analyses invasive fungal infections in neutropenic patients with haematological malignancies during antifungal prophylaxis with itraconazole. From September 1994 to December 1998 20 patients developed fungal infections. Two patients suffered from disseminated infections by yeasts and 18 patients suffered from pulmonary infections by moulds (eight proven, 10 highly probable in high-resolution CT scans). ⋯ Twelve patients died, six of these had refractory disease. Patients with fatal invasive fungal infections had lower median itraconazole concentrations immediately before occurrence of the infection than patients with non-fatal infections: 120 (0-478) ng ml-1 versus 690 (305-1908) ng ml-1 (P = 0.039). In conclusion, this analysis of breakthrough invasive fungal infections during prophylaxis with itraconazole demonstrates that patients with itraconazole trough concentrations below 500 ng ml-1 were significantly more likely to develop fungal infections and that the last itraconazole trough concentration before occurrence of the infection was significantly lower in patients with fatal invasive fungal infections.
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The total number of dermatophytoses (7393) included 2025 (27.4%) tinea pedis cases. Etiological factors in descending order by contribution were: Trichophyton rubrum (41.7%), Trichophyton mentagrophytes var. granulosum (30.9%), T. mentagrophytes var. interdigitale (10.0%), Epidermophyton floccosum (7.4%), T. mentagrophytes var. quinckeanum (6.9%), Trichophyton tonsurans (2.3%), Trichophyton spec. (0.4%), Trichophyton terrestre (0.2%), Trichophyton violaceum (0.1%). In the years 1987-93 the incidence of tinea pedis substantially increased over 1994-96. Today tinea pedis is second by incidence among all clinical forms of dermatophyte infections of skin and skin appendages in the Lódź region.