Delayed results of treatment of paracoccidioidomycosis with amphotericin B plus sulfamides versus amphotericin B alone

Abstract

A delayed evaluation of two groups of patients with paracoccidioidomycosis was carried out. Both groups were treated with amphotericin B, "but one of them was submitted to maintenance treatment with sulfonamides. Statistical analysis showed that treatment is more effective when patients are maintained with sulfonamide drugs.

Tropical dermatology: Fungal tropical diseases

“…87 Amphotericin B alone (3 mg/kg/d or on alternate days) or in combination with sulfamides is effective in severe cases of the disease. 81,88 Fluconazole is useful in patients with central nervous system lesions, and itraconazole is also useful in those with disseminated disease and progressive pulmonary infection. 89 Terbinafine has activity similar to that of itraconazole against P brasiliensis in vitro 90 and was used successfully to treat a case of disseminated PM (500 mg/d) with a follow-up of 2 years.…”

Paracoccidioidomycosis: an update

“…The former runs a more rapid course and is severer than the latter (116,123,198,222). In both cases, however, cell-mediated immune functions are abnormal, and in the absence of specific therapy, mortality is high (91,157,168 (113,116,198). Remission is often accompanied by significant pulmonary fibrosis (55,132,212).…”

“…This polyene proved to be more effective than sulfonamides and has since become a major tool for the treatment of patients with severe disseminated disease (56,91,246). Administered as indicated for other deep-seated mycoses and even in smaller, well-regulated doses (30), this drug achieves remission of most symptoms in 50 to 60% of patients, many of whom are in poor condition at diagnosis.…”

“…Administered as indicated for other deep-seated mycoses and even in smaller, well-regulated doses (30), this drug achieves remission of most symptoms in 50 to 60% of patients, many of whom are in poor condition at diagnosis. Unluckily, its known side effects and difficulties of administration are deterrents to its use; furthermore, even when combined with sulfonamides, the relapse rate with amphotericin B is still quite high (20 to 30%) (32,91). The efficacy of amphotericin B also depends on physician supervision, which is not always available in areas where the disease is endemic (32).…”

“…The efficacy of amphotericin B also depends on physician supervision, which is not always available in areas where the disease is endemic (32). It has been customary to follow the course of amphotericin B with prolonged oral sulfonamide therapy to maintain remission (32,86,91). …”