Drug therapy for Mycetoma

Linezolid: A novel treatment option for the treatment of a non-responsive case of actinomycotic mycetoma

“…Culture is negative in majority of the cases, so information regarding antibiotic sensitivity is usually not available and the treatment is given empirically. 8 Welsh regimen (consisting of co-trimoxazole with amikacin for 3 weeks, followed by only co-trimoxazole for 2 weeks (constituting 1 pulse) for one to four such cycles 9 and modified Ramam's two-step regimen ("intensive phase" of co-trimoxazole and gentamicin for 4 weeks followed by a "maintenance phase" of co-trimoxazole and doxycycline) 10,11 are the commonly used therapeutic regimens. Other modifications of the original Welsh regimen include adding rifampicin, dapsone, doxycycline and streptomycin in different combinations, or increasing the number of cycles, particularly in cases of bony involvement.…”

“…Other modifications of the original Welsh regimen include adding rifampicin, dapsone, doxycycline and streptomycin in different combinations, or increasing the number of cycles, particularly in cases of bony involvement. 8 In highly refractory cases, agents such as netilmicin can replace amikacin or an alternative treatment regimen like imipenem alone or with amikacin or amoxicillin-clavulanic acid have been used. Most have shown a cure rate of almost 90% with a treatment non-responsiveness in around 10% of cases.…”

“…Most have shown a cure rate of almost 90% with a treatment non-responsiveness in around 10% of cases. 8 Therefore, it is important to have alternative drugs in the management of actinomycetoma. Linezolid has been found to have significant in vitro activity against Actinomadurae spp.…”

The Activity of 2,3-Dimethylquinoxaline against Madurella mycetomatis

“…The current antifungal therapy mainly helps to localize the disease for easily surgical excision. Itraconazole replaced ketoconazole as the standard gold therapy after concerns of adrenal insufficiency and liver injury [9,10]. Posaconazole was found to be a clinically successful antifungal therapy for refractory cases (Table 1) [11].…”

A Case of Bilateral Painful Eumycetoma of the Feet Responding Excellently to Low Dose Itraconazole

“…Itraconazole, a triazole antifungal drug, was released in the early 1990s and has become the most commonly used drug for the treatment of eumycetoma when and where it is affordable. [ 5 6 ] On extensive literature search, we found almost all cases of eumycetoma reported so far required combined surgical clearance and antifungal therapy. Only a few cases responded excellently to medical therapy that too to voriconazole and posaconazole.…”