title: Madurella mycetomatis is highly susceptible to ravuconazole.
abstract: The current treatment of eumycetoma utilizing ketoconazole is unsatisfactory because of high recurrence rates, which often leads to complications and unnecessary amputations, and its comparatively high cost in endemic areas. Hence, an effective and affordable drug is required to improve therapeutic outcome. E1224 is a potent orally available, broad-spectrum triazole currently being developed for the treatment of Chagas disease. E1224 is a prodrug that is rapidly converted to ravuconazole. Plasma levels of E1224 are low and transient, and its therapeutically active moiety, ravuconazole is therapeutically active. In the present study, the in vitro activity of ravuconazole against Madurella mycetomatis, the most common etiologic agent of eumycetoma, was evaluated and compared to that of ketoconazole and itraconazole. Ravuconazole showed excellent activity with MICs ranging between ≤ 0.002 and 0.031 µg/ml, which were significantly lower than the MICs reported for ketoconazole and itraconazole. On the basis of our findings, E1224 with its resultant active moiety, ravuconazole, could be an effective and affordable therapeutic option for the treatment of eumycetoma.
authors.affiliation: Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan; Centraalbureau voor Schimmelcultures CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands; Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, The Netherlands.
authors.forename: Sarah Abdalla
authors.initials: SA
authors.lastname: Ahmed
authors.affiliation: Erasmus MC, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands.
authors.forename: Wendy
authors.initials: W
authors.lastname: Kloezen
authors.affiliation: Eisai Inc., Woodcliff Lake, New Jersey, United States of America.
authors.forename: Frederick
authors.initials: F
authors.lastname: Duncanson
authors.affiliation: Rotterdam Centre for Tropical Medicine, Rotterdam, The Netherlands.
authors.forename: Ed E
authors.initials: EE
authors.lastname: Zijlstra
authors.affiliation: Centraalbureau voor Schimmelcultures CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands; Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, The Netherlands; Peking University Health Science Center, Research Center for Medical Mycology, Beijing, China; Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Shanghai Institute of Medical Mycology, Changzheng Hospital, Second Military Medical University, Shanghai, China; Basic Pathology Department, Federal University of Paraná State, Curitiba, Paraná, Brazil; King Abdulassiz University, Jeddah, Saudi Arabia.
authors.forename: G Sybren
authors.initials: GS
authors.lastname: de Hoog
authors.affiliation: Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan.
authors.forename: Ahmed H
authors.initials: AH
authors.lastname: Fahal
authors.affiliation: Erasmus MC, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands.
authors.forename: Wendy W J
authors.initials: WW
authors.lastname: van de Sande
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology*; D017964:Itraconazole / Q000494:pharmacology; D007654:Ketoconazole / Q000494:pharmacology; D020461:Madurella / Q000187:drug effects*; D008826:Microbial Sensitivity Tests; D013844:Thiazoles / Q000494:pharmacology*; D014230:Triazoles / Q000494:pharmacology*
chemical_list: D000935:Antifungal Agents; D013844:Thiazoles; D014230:Triazoles; D017964:Itraconazole; C104066:ER 30346; D007654:Ketoconazole