Itraconazole is an orally active
triazole antifungal
drug which has demonstrated a broad spectrum of activity and a favourable pharmacokinetic profile. It is a potent inhibitor of most human fungal pathogens including Aspergillus sp. In non-comparative clinical trials
itraconazole was shown to be extremely effective in a wide range of superficial and more serious 'deep'
fungal infections when administered once or twice daily. Generally, greater than 80% of patients with superficial dermatophyte or yeast
infections are cured by
itraconazole. Similarly, good to excellent response rates (clinical cure or marked improvement) are achieved in
paracoccidioidomycosis,
histoplasmosis,
sporotrichosis,
blastomycosis,
systemic candidiasis,
coccidioidomycosis,
chromomycosis,
aspergillosis and
cryptococcosis. Understandably, given the rare nature of some of these diseases, clinical experience is relatively limited and further evaluation, preferably controlled trials with
amphotericin B and
ketoconazole, would help clarify the ultimate role
itraconazole will have in their management. Preliminary findings also indicate that
itraconazole may hold promise for the prophylaxis of opportunistic
fungal infections in patients at risk, for example women with chronic recurrent vaginal
candidiasis, immunodeficient patients with
chronic mucocutaneous candidiasis,
AIDS patients and patients receiving
immunosuppressant drugs. In studies to date
itraconazole has been very well tolerated. Transient changes in indices of liver function occurred in 1 to 2% of patients; however, symptomatic
liver dysfunction (as occurs infrequently with
ketoconazole) has not been reported. Wider clinical experience is needed to permit clear conclusions as to whether
liver dysfunction can result from
itraconazole administration. Thus, while several aspects of the
drug's profile require further investigation,
itraconazole is a promising new oral treatment of
fungal disease. The extent to which
itraconazole will be employed in preference to
ketoconazole will be clarified by wider clinical experience.