Comparison between Itraconazole and Cotrimoxazole in the Treatment of Paracoccidiodomycosis
Autor(a) principal: | |
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Data de Publicação: | 2014 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.1371/journal.pntd.0002793 http://hdl.handle.net/11449/112221 |
Resumo: | BackgroundThere are no published reports on studies comparing itraconazole (ITC), sulfamethoxazole-trimethoprim (cotrimoxazole, CMX), and ITC followed by CMX (ITC/CMX) in the treatment of paracoccidiodomycosis. This study aimed to compare the efficacy, effectiveness, safety and time to clinical and serologic cure in paracoccidioidomycosis patients treated with ITC or CMX, the antifungal agents most widely used.MethodologyA quasi-experimental study was performed in 177 patients with a confirmed or probable diagnosis of paracoccidioidomycosis. Treatment was divided into two stages: 1) initial, which was continued until clinical cure was achieved and the erythrocyte sedimentation rate decreased to normal values; 2) complementary, which was continued until serologic cure was achieved. Medians were compared via the Mann-Whitney test, and frequencies were compared via the chi-squared test. The assessment of variables as a function of time was performed using Kaplan-Meier curves and Cox regression. The significance level was established as p <= 0.05.Principal FindingsNo difference was found in the efficacy and effectiveness of the initial treatment of 47 individuals given ITC and 130 individuals given CMX; however, the time to clinical cure was shorter in the former compared with the latter group (105 vs. 159 days; p = 0.001), specifically in patients with the chronic form. Efficacy and effectiveness of the three regimens were similar in the complementary treatment; however, the time to serologic cure was shorter when ITC (161 days) or CMX (495 days) was used compared with ITC/CMX (881 days) [p = 0.02]. The independent predictors of a shorter time to serologic cure were treatment with ITC [risk ratio = 6.61 (2.01-21.75)] or with CMX [risk ratio = 5.11 (1.91-13.67)]). The prevalence of side effects was lower with ITC (6.4%) than with CMX (20.0%; p = 0.03).ConclusionsSince ITC induced earlier clinical cure and was better tolerated than CMX, such triazole should be considered the first-choice for PCM treatment. |
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Comparison between Itraconazole and Cotrimoxazole in the Treatment of ParacoccidiodomycosisBackgroundThere are no published reports on studies comparing itraconazole (ITC), sulfamethoxazole-trimethoprim (cotrimoxazole, CMX), and ITC followed by CMX (ITC/CMX) in the treatment of paracoccidiodomycosis. This study aimed to compare the efficacy, effectiveness, safety and time to clinical and serologic cure in paracoccidioidomycosis patients treated with ITC or CMX, the antifungal agents most widely used.MethodologyA quasi-experimental study was performed in 177 patients with a confirmed or probable diagnosis of paracoccidioidomycosis. Treatment was divided into two stages: 1) initial, which was continued until clinical cure was achieved and the erythrocyte sedimentation rate decreased to normal values; 2) complementary, which was continued until serologic cure was achieved. Medians were compared via the Mann-Whitney test, and frequencies were compared via the chi-squared test. The assessment of variables as a function of time was performed using Kaplan-Meier curves and Cox regression. The significance level was established as p <= 0.05.Principal FindingsNo difference was found in the efficacy and effectiveness of the initial treatment of 47 individuals given ITC and 130 individuals given CMX; however, the time to clinical cure was shorter in the former compared with the latter group (105 vs. 159 days; p = 0.001), specifically in patients with the chronic form. Efficacy and effectiveness of the three regimens were similar in the complementary treatment; however, the time to serologic cure was shorter when ITC (161 days) or CMX (495 days) was used compared with ITC/CMX (881 days) [p = 0.02]. The independent predictors of a shorter time to serologic cure were treatment with ITC [risk ratio = 6.61 (2.01-21.75)] or with CMX [risk ratio = 5.11 (1.91-13.67)]). The prevalence of side effects was lower with ITC (6.4%) than with CMX (20.0%; p = 0.03).ConclusionsSince ITC induced earlier clinical cure and was better tolerated than CMX, such triazole should be considered the first-choice for PCM treatment.Univ Estadual Paulista UNESP, Dept Trop Dis, Fac Med Botucatu, Botucatu, Sao Paulo State, BrazilInst Biociencias Botucatu UNESP, Sao Paulo, BrazilUniv Estadual Paulista UNESP, Dept Trop Dis, Fac Med Botucatu, Botucatu, Sao Paulo State, BrazilInst Biociencias Botucatu UNESP, Sao Paulo, BrazilPublic Library ScienceUniversidade Estadual Paulista (Unesp)Cavalcante, Ricardo de Souza [UNESP]Sylvestre, Tatiane Fernanda [UNESP]Levorato, Adriele Dandara [UNESP]Carvalho, Lidia Rachel de [UNESP]Mendes, Rinaldo Poncio [UNESP]2014-12-03T13:10:32Z2014-12-03T13:10:32Z2014-04-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article11application/pdfhttp://dx.doi.org/10.1371/journal.pntd.0002793Plos Neglected Tropical Diseases. San Francisco: Public Library Science, v. 8, n. 4, 11 p., 2014.1935-2735http://hdl.handle.net/11449/11222110.1371/journal.pntd.0002793WOS:000335342400028WOS000335342400028.pdfWeb of Sciencereponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengPLoS Neglected Tropical Diseases4.3672,589info:eu-repo/semantics/openAccess2023-10-28T06:04:42Zoai:repositorio.unesp.br:11449/112221Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462023-10-28T06:04:42Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Comparison between Itraconazole and Cotrimoxazole in the Treatment of Paracoccidiodomycosis |
title |
Comparison between Itraconazole and Cotrimoxazole in the Treatment of Paracoccidiodomycosis |
spellingShingle |
Comparison between Itraconazole and Cotrimoxazole in the Treatment of Paracoccidiodomycosis Cavalcante, Ricardo de Souza [UNESP] |
title_short |
Comparison between Itraconazole and Cotrimoxazole in the Treatment of Paracoccidiodomycosis |
title_full |
Comparison between Itraconazole and Cotrimoxazole in the Treatment of Paracoccidiodomycosis |
title_fullStr |
Comparison between Itraconazole and Cotrimoxazole in the Treatment of Paracoccidiodomycosis |
title_full_unstemmed |
Comparison between Itraconazole and Cotrimoxazole in the Treatment of Paracoccidiodomycosis |
title_sort |
Comparison between Itraconazole and Cotrimoxazole in the Treatment of Paracoccidiodomycosis |
author |
Cavalcante, Ricardo de Souza [UNESP] |
author_facet |
Cavalcante, Ricardo de Souza [UNESP] Sylvestre, Tatiane Fernanda [UNESP] Levorato, Adriele Dandara [UNESP] Carvalho, Lidia Rachel de [UNESP] Mendes, Rinaldo Poncio [UNESP] |
author_role |
author |
author2 |
Sylvestre, Tatiane Fernanda [UNESP] Levorato, Adriele Dandara [UNESP] Carvalho, Lidia Rachel de [UNESP] Mendes, Rinaldo Poncio [UNESP] |
author2_role |
author author author author |
dc.contributor.none.fl_str_mv |
Universidade Estadual Paulista (Unesp) |
dc.contributor.author.fl_str_mv |
Cavalcante, Ricardo de Souza [UNESP] Sylvestre, Tatiane Fernanda [UNESP] Levorato, Adriele Dandara [UNESP] Carvalho, Lidia Rachel de [UNESP] Mendes, Rinaldo Poncio [UNESP] |
description |
BackgroundThere are no published reports on studies comparing itraconazole (ITC), sulfamethoxazole-trimethoprim (cotrimoxazole, CMX), and ITC followed by CMX (ITC/CMX) in the treatment of paracoccidiodomycosis. This study aimed to compare the efficacy, effectiveness, safety and time to clinical and serologic cure in paracoccidioidomycosis patients treated with ITC or CMX, the antifungal agents most widely used.MethodologyA quasi-experimental study was performed in 177 patients with a confirmed or probable diagnosis of paracoccidioidomycosis. Treatment was divided into two stages: 1) initial, which was continued until clinical cure was achieved and the erythrocyte sedimentation rate decreased to normal values; 2) complementary, which was continued until serologic cure was achieved. Medians were compared via the Mann-Whitney test, and frequencies were compared via the chi-squared test. The assessment of variables as a function of time was performed using Kaplan-Meier curves and Cox regression. The significance level was established as p <= 0.05.Principal FindingsNo difference was found in the efficacy and effectiveness of the initial treatment of 47 individuals given ITC and 130 individuals given CMX; however, the time to clinical cure was shorter in the former compared with the latter group (105 vs. 159 days; p = 0.001), specifically in patients with the chronic form. Efficacy and effectiveness of the three regimens were similar in the complementary treatment; however, the time to serologic cure was shorter when ITC (161 days) or CMX (495 days) was used compared with ITC/CMX (881 days) [p = 0.02]. The independent predictors of a shorter time to serologic cure were treatment with ITC [risk ratio = 6.61 (2.01-21.75)] or with CMX [risk ratio = 5.11 (1.91-13.67)]). The prevalence of side effects was lower with ITC (6.4%) than with CMX (20.0%; p = 0.03).ConclusionsSince ITC induced earlier clinical cure and was better tolerated than CMX, such triazole should be considered the first-choice for PCM treatment. |
publishDate |
2014 |
dc.date.none.fl_str_mv |
2014-12-03T13:10:32Z 2014-12-03T13:10:32Z 2014-04-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1371/journal.pntd.0002793 Plos Neglected Tropical Diseases. San Francisco: Public Library Science, v. 8, n. 4, 11 p., 2014. 1935-2735 http://hdl.handle.net/11449/112221 10.1371/journal.pntd.0002793 WOS:000335342400028 WOS000335342400028.pdf |
url |
http://dx.doi.org/10.1371/journal.pntd.0002793 http://hdl.handle.net/11449/112221 |
identifier_str_mv |
Plos Neglected Tropical Diseases. San Francisco: Public Library Science, v. 8, n. 4, 11 p., 2014. 1935-2735 10.1371/journal.pntd.0002793 WOS:000335342400028 WOS000335342400028.pdf |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
PLoS Neglected Tropical Diseases 4.367 2,589 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
11 application/pdf |
dc.publisher.none.fl_str_mv |
Public Library Science |
publisher.none.fl_str_mv |
Public Library Science |
dc.source.none.fl_str_mv |
Web of Science reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
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Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
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1797789533132029952 |