Drugs for treating paracoccidioidomycosis.
Abstract
Background
Paracoccidioidomycosis is a fungal infection that occurs only in some
particular places in Latin America. Treatment is long, the drugs have
side effects, and patients can relapse. However, the disease is
potentially fatal.
Objectives
To evaluate drugs for treating paracoccidioidomycosis.
Search strategy
We searched the following databases: Cochrane Infectious Diseases Group
Specialized Register (March 2011); Cochrane Central Register of
Controlled Trials (CENTRAL), published in The Cochrane Library (2011,
Issue 1); PubMed (1966 to March 2011); EMBASE (1974 to March 2011); and
LILACS (1982 to March 2011)
Selection criteria
Randomized controlled trials comparing drugs for treating people with
paracoccidioidomycosis.
Data collection and analysis
Two authors independently assessed trial eligibility and risk of bias,
and extracted data, including adverse events.
Main results
Two trials, one with 42 participants and another with 53 participants
met the inclusion criteria. Risk of bias in the two trials was high, but
most patients showed considerable clinical and mycological improvement.
The first trial compared imidazoles (itraconazole and ketoconazole) with
sulfadiazine (n=42). No difference was detected for cure (RR 0.77, 95%
CI 0.52 to 1.16) or clinical improvement, or serological titres after 10
months of treatment, and there was no difference detected in adverse
events. The second compared voriconazole with itraconazole (n=53) and
did not demonstrate a difference in response. Two patients were
withdrawn from voriconazole due to raised liver enzymes.
Authors' conclusions
The small number of participants and the short follow-up period impede
definitive conclusions on comparative effects.
Plain language summary
Not enough good quality trials to assess the most effective drug
treatment for paracoccidioidomycosis. Paracoccidioidomycosis is a fungal
infection that causes ulcers, swelling, fever, and pain. If it also gets
into the lungs, it can produce coughing, shortage of breath, chest pain,
weight loss, and sometimes death. Without treatment, those suffering
this disease may die in a few months or years. There are endemic areas
between Mexico and southern Argentina. Drug treatments need to go on for
many months and maybe years. There are various drugs that are used, but
this review found only two small trials with too few data to say which
drug was best, and the drugs all seem to have adverse effects. More
research is needed.
Assessed as up-to-date: 8 MAR 2011.
Citation
Menezes, V. da M.; Soares, B. G. O; Fontes, C. J. F. Drugs for treating paracoccidioidomycosis. Cochrane Database of Systematic Reviews (2006) (Issue 2) Art. No.:CD004967. [DOI: 10.1002/14651858.CD004967.pub2]