Comparison of fluconazole and itraconazole for treatment of rhinomaxillary mucormycosis

Abstract

Aim: Rhinomaxillary mucormycosis (RMM) is a detrimental and progressive deep fungal infection which predominantly affects immunocompromised patients. The disease has heterogeneity in clinical manifestation and presents with unfavorable consequences. Despite recent advances in the diagnosis and treatment, the disease has inadequate prognosis overall. The aim of our study is to compare Fluconazole vs. Itraconazole for the management of RMM.

Methods: We retrieved demographic, clinical, radiological and histopathological data of patients affected with osteomyelitis in head and neck region and 33 patients exclusively affected with RMM were separated from departmental records. Several characteristics such as Gender, age, Diabetic status, co-morbidity were observed. Patients were randomly distributed in two groups with respect to the azole drug prescribed to them. Group A was given Fluconazole while group B was given Itraconazole. Aggressive surgery with concomitant use of antifungal drug was the mandatory treatment in all patients. Regular monitoring of side effects of drugs and recurrence was carried out for prolonged time.

Results: Overall, 18 patients were male and 15 patients were female with a ratio of M:F 1.2. Mean age of patients was 48.21 (11.66) with the age range from 25 years to 70 years. Out of 33 patients, 30 of the patients (90.9%) were diabetic. Fifteen patients in Group A were managed with Fluconazole while 18 patients in group B were treated with Itraconazole. There was no statistically significant difference observed in most of the clinical signs and symptoms presented in both groups as p>0.05 except for bone necrosis (P=0.381). In group A, 4 patients exhibited recurrence (26.6%) while in group B, 5 (27.7%) patients presented with recurrence (p=0.943).

Conclusion: Aggressive surgical approach along with supportive antifungal medication remained the mainstay of the treatment. Between Fluconazole and Itraconazole there was no difference observed.

Keywords

• Fluconazole,Rhinomaxillary mucormycosis,Itraconazole

Rhinomaksiler mukormikoz tedavisinde flukonazol ve itrakonazolun karşılaştırılması

Öz

Amaç: Çalışmamızın amacı, rhinomaksiler mukormikoz (RMM) tedavisi için Fluconazole - Itraconazole uygulamasını karşılaştırmaktır.

Yöntemler: Baş ve boyun bölgesinde osteomiyelit ile etkilenen hastaların demografik, klinik, radyolojik ve histopatolojik verilerini aldık ve sadece RMM'den etkilenen 33 hasta bölümsel kayıtlardan ayrıldı. Cinsiyet, yaş, diyabetik durum, komorbidite gibi çeşitli özellikler kaydedildi. Hastalar, kendilerine verilen azol ilacı açısından rastgele iki gruba ayrıldı. A grubuna Flukonazol, B grubuna Itrakonazol verildi. Antifungal ilacın birlikte kullanılması ile yapılan agresif cerrahi, tüm hastalarda zorunlu tedavi idi. İlaçların yan etkilerinin düzenli olarak izlenmesi ve tekrarlama uzun süre takip edildi.

Bulgular: Toplamda 18 hasta erkek, 15 hasta kadındı (E/K 1,2). Hastaların yaş ortalaması 48.21 (11,66), yaşları 25 ile 70 arasında değişmekteydi. 33 hastanın 30'u (%90,9) diyabetikti. Grup A'da 15 hasta Fluconazole ile tedavi edilirken, grup B'de 18 hasta Itraconazole ile tedavi edildi. Kemik nekrozu dışında her iki grupta da sunulan klinik belirti ve semptomların çoğunda p>0.05 düzeyinde istatistiksel olarak anlamlı bir fark bulunmadı (P=0.381). Grup A'da 4 hastada nüks görüldü (%26,6), grup B'de ise 5 hastada (%27,7) nüks saptandı (p=0,943).

Sonuç: Destekleyici antifungal ilaçlar ile birlikte agresif cerrahi yaklaşım tedavinin dayanak noktası olarak kaldı. Flukonazol ve Itrakonazol arasında anlamlı bir fark gözlenmedi.

Anahtar Kelimeler

• Flukonazol,Itrakonazol,Rhinomaksiler mukormikoz

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