Treatment compliance of patients with paracoccidioidomycosis in Central-West Brazil

Abstract

Objective: To evaluate the treatment compliance of patients with paracoccidioidomycosis. Methods: We studied 188 patients with paracoccidioidomycosis admitted to a tertiary referral hospital in the Central-West Region of Brazil from 2000 to 2010, to assess their compliance to treatment. In order to be considered compliant, patients needed to present two established criteria: (1) receive medicines from the pharmacy, and (2) achieve a self-reported utilization of at least 80% of the dispensed antifungal compounds prescribed since their previous appointment. Results: Most patients were male (95.7%), had the chronic form of the disease (94.2%), and were treated with cotrimoxazole (86.2%). Only 44.6% of patients were treatment compliant. The highest loss to follow-up was observed in the first 4 months of treatment (p < 0.02). Treatment compliance was higher for patients with than for those without pulmonary involvement (OR: 2.986; 95%CI 1.351-6.599), and higher for patients with than without tuberculosis as co-morbidity (OR: 2.763; 95%CI 1.004-7.604). Conclusions: Compliance to paracoccidioidomycosis treatment was low, and the period with the highest loss to follow-up corresponds to the first four months. Pulmonary paracoccidioidal involvement or tuberculosis comorbidity predicts a higher compliance to paracoccidioidomycosis therapy.

Paracoccidioidomycosis: What We Know and What Is New in Epidemiology, Diagnosis, and Treatment

“…Until 2005, Paracoccidioides brasiliensis was considered the only species that caused PCM. In 2006, Matute et al [ 13 ], through genotypic studies, revealed variations in P. brasiliensis encompassing four genetic variants (S1, PS2, PS3, and PS4) [ 12 ]. In 2009, Teixeira et al [ 14 ] described the new species Paracoccidioides lutzii in the midwest region of Brazil.…”

“…Currently, the drug is available in almost all Latin American countries, but with a limited presence in non-referral hospitals and at a high cost [ 6 ]. Moreover, intravenous formulations of itraconazole are not easily available, and the oral absorption of capsules is erratic, leading to unpredictable supratherapeutic or subtherapeutic plasma levels [ 12 ]. To overcome this limitation, a novel formulation of ITZ, labeled SUper BioAvailable (SUBA)-itraconazole, was developed, with a relative bioavailability of 180% when compared with conventional itraconazole (C-ITZ), and an absolute bioavailability up to 90%.…”

“…Although itraconazole has been proven to be more effective than cotrimoxazole to treat mild and moderate PCM, in Latin America, the last is still largely used because of its lower cost. Similarly, although the lipid formulations of amphotericin B are less toxic than the conventional one, their high price limits its use in low-income countries [ 10 , 11 , 12 ].…”

Overview of Antifungal Drugs against Paracoccidioidomycosis: How Do We Start, Where Are We, and Where Are We Going?

“…Even after one hundred years of investigation into the disease, the therapeutic approaches face several issues. The main problem to overcome concerns the long period of treatment required by the currently available antifungals, which occasionally results in patients giving up therapy [ 26 ]. Another issue is the possibility of Paracoccidioides developing resistance against these antifungals.…”

Paracoccidioidomicose: uma revisão clínico-epidemiológica de casos com lesões orais em 24 anos

“…11 A adesão por parte dos pacientes com paracoccidioidomicose é baixa e o período com maior perda de acompanhamento corresponde ao período dos primeiros quatro meses. 12 O objetivo do presente estudo foi realizar uma análise retrospetiva do perfil epidemiológico, clínico, do tratamento e prognóstico de 59 pacientes, brasileiros, diagnosticados entre 1994 e 2018 com lesões orais de paracoccidioidomicose e acompanhados após o tratamento.…”