The
imidazoles have been appreciated for approximately fifteen years as a family of antifungals. Most derivatives, like the protype compounds,
miconazole and
clotrimazole, are effective only in a topical dose form. The topical
imidazoles are generally thought to be superior to other topical antifungals. The first orally available
imidazole,
ketoconazole has ushered in a new era of potent, oral, broad-spectrum antifungal
therapy. The
imidazoles as a class are the treatment of choice for four
dermatophyte infection syndromes. They are the preferred alternative
therapy in another six syndromes. There is insufficient data to recommend one topical
azole over the other. The topicals are inadequate for control of six clinical-anatomical
infection syndromes.
Griseofulvin remains the standard oral
therapy in all situations except chronic, extensive
dermatophytosis, where
ketoconazole has proven to be more efficacious. The recognition of potential significant adverse effects, namely an idiopathic
hepatitis and dose-dependent adrenal and testicular dysfunction have reduced
ketoconazole's potential role in the
dermatophytoses.
Ketoconazole is a useful alternative to
griseofulvin when oral
therapy is required and the causative organism is insensitive to
griseofulvin, or
infection fails to respond to
griseofulvin, or
griseofulvin is contraindicated due to
allergy, photosensitivity, porphyrinuria, intolerance, etc.