Oral itraconazole therapy for superficial, subcutaneous, and systemic infections. A panoramic view.

The availability of the oral triazole agents itraconazole and fluconazole has revolutionized antifungal therapy. Although there are still some limitations and treatment failures, these agents have allowed for improved efficacy, increased safety, reduced morbidity, decreased mortality from systemic fungal disease, and a shift toward increased outpatient therapy for fungal infections that are not life-threatening. The treatment of superficial infections also has been enhanced by the development of effective intermittent and short-course regimens. Itraconazole exhibits broad-spectrum in vitro activity against several fungal organisms, including Trichophyton species, Candida albicans, Pityrosporum species, Aspergillus flavus, Aspergillus fumigatus, Blastomyces dermatitidis, Histoplasma capsulatum, Histoplasma capsulatum var duboisii, Sporothrix schenckii, and Cryptococcus neoformans. Animal model studies have confirmed the broad-spectrum in vivo activity of itraconazole. Multiple clinical studies and extensive clinical experience have substantiated the versatility of itraconazole, with good efficacy demonstrated in a wide variety of infections in humans. Itraconazole is approved for use in several countries for dermatomycoses, onychomycosis, oral-esophageal candidiasis, vaginal candidiasis, histoplasmosis, blastomycosis, aspergillosis, and fungal keratitis. Pulse therapy regimens for dermatomycoses and onychomycosis of the toenails or fingernails have been approved in several countries.