Treatment of fungal infections in the bones and joints with ketoconazole.

Seven patients with fungal infections in the bones and joints were treated with ketoconazole. One patient had aspergillosis, two had sporotrichosis, and four had coccidioidomycosis. All of the organisms that were tested demonstrated in vitro sensitivity to ketoconazole. Patients were treated with 200-600 mg of oral ketoconazole per day for a minimum of six months. Initially four of seven patients responded to therapy, but only one was cured. The other three patients did not respond. Treatment failure may be due to poor penetration of ketoconazole into bone. Ketoconazole will not cure fungal osteomyelitis, but it may be useful in conjunction with surgical debridement. Chronic suppressive therapy with ketoconazole is well tolerated but may not prevent metastatic fungal infection.