title: Itraconazole vs. trimethoprim-sulfamethoxazole: A comparative cohort study of 200 patients with paracoccidioidomycosis.
abstract: Paracoccidioidomycosis (PCM) is a systemic mycosis endemic to Latin America. Brazil accounts for approximately 80% of cases, where it represents a major public health issue due to its disabling impact and the number of premature deaths it causes. We present a retrospective cohort study that was conducted in order to better understand factors that relate to cure of the infection in the treatment of 200 patients with PCM. We evaluated the influence of sociodemographic and clinical factors as well as therapeutic regimen (trimethoprim-sulfamethoxazole [TMP-SMX] and itraconazole) on the progress of PCM (cure and noncure). There was a higher incidence of cure (83%) among patients who regularly received treatment for their infections and completed the treatment protocol. Moreover, itraconazole (86.4%) was significantly superior to TMP-SMX (51.3%) in terms of cure rate and had a median treatment period that was significantly shorter (12 months) than that for TMP-SMX (23 months). A Cox proportional hazard regression model showed that use of itraconazole increased the hazard of cure, regardless of sex, age, education, clinical form, completion of treatment, and regularity. Although the results of this study show that itraconazole was the best treatment option for PCM patients, a double-blind, randomized, controlled trial is necessary to confirm this conclusion.
authors.affiliation: Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
authors.forename: Sheila Rocha Conceição
authors.initials: SR
authors.lastname: Borges
authors.forename: Gilberto Marcelo Sperandio da
authors.initials: GM
authors.lastname: Silva
authors.forename: Mayara da Costa
authors.initials: Mda C
authors.lastname: Chambela
authors.forename: Raquel de Vasconcellos C de
authors.initials: Rde V
authors.lastname: Oliveira
authors.forename: Regina Lana Braga
authors.initials: RL
authors.lastname: Costa
authors.forename: Bodo
authors.initials: B
authors.lastname: Wanke
authors.forename: Antonio Carlos Francesconi do
authors.initials: AC
authors.lastname: Valle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D001938:Brazil; D015331:Cohort Studies; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010229:Paracoccidioidomycosis / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: itraconazole; paracoccidioidomycosis; treatment; trimethoprim-sulfamethoxazole (TMP–SMX)