Emerging therapeutic regimes for the management of mycetomas.
BACKGROUND
Mycetomas are chronic, granulomatous, subcutaneous infections caused by either actinomycetes bacteria or eumycetes fungi. The disease is endemic in the tropics and is characterised by a slow progression with risks of bone and visceral involvement. Therapy has consisted of prolonged courses of antibiotics or antifungals, often combined with surgery. The long treatment duration, poor therapy response and high rates of relapse have prompted trials of novel antibiotics and antifungals.


OBJECTIVE
The aim of this study was to describe recent advances and developments in the diagnosis, prognosis and treatment of mycetomas.


METHODS
An extensive review of the literature was conducted into all aspects of the management of mycetomas, with a particular focus on novel drug therapy regimes.


CONCLUSIONS
There have been notable advances in improved molecular techniques for species identification. Carbapenems, oxazolidinones and triazoles have emerged as promising therapeutic options, but access to drug therapies in developing countries remains limited by the poor availability and high costs.
Ameen
Mahreen
M
Royal Free Hospital, Department of Dermatology, London NW3 2QG, UK. mahreenameen@hotmail.com
Arenas
Roberto
R
D039903:Actinobacteria; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use; D006801:Humans; D020461:Madurella; D008271:Mycetoma / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology* / Q000601:surgery; D023303:Oxazolidinones / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D015780:Carbapenems; D023303:Oxazolidinones; D014230:Triazoles