Fungal disease ketoconazole

Fluconazole (Diflucan) may be better absorbed and is possibly less hepatotoxic than ketoconazole, but it is considerably more expensive, an important consideration given the required length of therapy for most cutaneous fungal diseases. 

H. B. Levine, Ketoconazole in the Management of Fungal Disease Adis Press, Sydney, Australia, 1982. 

Ketoconazole (KC) as the first systemlcally-active azole antifungal has been the subject of a number of reviews including the general management of fungal disease,and its efficacy in superficial and systemic infections 0 it was the subject of a number of papers at a recent symposium, The use of KC in the treatment of coccidioidomycosis has been recently reviewed in detail, 2 gjid parallel reviews of the indications for coccidioidomycosis treatment in general, 5 and the use of AMB and miconazole (MC) 5 in particular have been presented. 

Meunier-Carpentier F, Cruciani M, Klastersky J. Oral propl laxis with miconazole or ketoconazole of invasive fungal disease in neutropenic cancer patients. EurJ Cancer Clin Oncol (1983) 19,43-8. 

Systemic fungal diseases (e.g. histoplasmosis and blastomycosis) are uncommon but, if untreated, often fatal. They usually take the form of lung infections or meningitis. The best treatment is still the polyene antibiotic, amphotericin B 5.14) whose mode of action is described in Section 5.4.1 (p. 192). It is usually administered intravenously. Flucytosine 4.23) is an excellent synergist (Section 4.0, p. 131), seldom given alone. Intravenous miconazole 6.23) provides alternative therapy, but there are frequent adverse reactions. An orally active analogue, ketoconazole ( Nizoral ) was introduced in 1981, and looks promising. 

For systemic treatment of fungal infections in dogs and cats, ketoconazole and fluconazole are available as tablets and oral suspensions, itraconazole as capsules, while miconazole and fluconazole are available as parenteral solutions. Even though ketoconazole is often effective, itraconazole may be the preferred azole for the treatment of systemic disease caused by dimorphic fungi (Blastomyces dermatitidis, Histoplasma capsulatum, Sporothrix schenckii). The activity of fluconazole against dimorphic fungi is limited to coccidioidal disease (Coccidioides immitis), but this azole penetrates the blood-brain barrier. 

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