Cure of orthopaedic infection with Scedosporium prolificans, using voriconazole plus terbinafine, without the need for radical surgery

Summary Scedosporium prolificans infections of normal hosts usually require extensive debridement and sometimes amputation to effect cure, due to the intrinsic resistance of this species to available antifungal agents. Newer agents have not tested favourably. Variable results are obtained with voric...

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Bibliographic Details
Published in:Mycoses 2003-06, Vol.46 (5‐6), p.233-236
Main Authors: Gosbell, I. B., Toumasatos, V., Yong, J., Kuo, R. S., Ellis, D. H., Perrie, R. C.
Format: Article
Language:English
Subjects:
Aged
Ankle Injuries - drug therapy
Ankle Injuries - microbiology
Antifungal Agents - therapeutic use
antimycotic chemotherapy
antimykotische Chemotherapie
Debridement
Drug Synergism
Drug Therapy, Combination
Humans
Male
Microbial Sensitivity Tests
Mycetoma - drug therapy
Mycetoma - microbiology
Mycetoma - surgery
Naphthalenes - therapeutic use
Pyrimidines - therapeutic use
Scedosporium - drug effects
Scedosporium prolificans
Synergismus
synergy
Terbinafin
terbinafine
Triazoles - therapeutic use
Voriconazol
Voriconazole
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Summary:Summary Scedosporium prolificans infections of normal hosts usually require extensive debridement and sometimes amputation to effect cure, due to the intrinsic resistance of this species to available antifungal agents. Newer agents have not tested favourably. Variable results are obtained with voriconazole, and 100% resistance is described with echinocandins. Itraconazole and terbinafine has offered synergy against various moulds including S. prolificans. In vivo success is reported with the azole/terbinafine combination in S. apiospermum pulmonary infection and Pythium insidiosum periorbital cellulitis. We report a case of orthopaedic infection in a non‐immunocompromised host with S. prolificans, in which the combinations of itraconazole/terbinafine and voriconazole/terbinafine showed synergy in vitro, and success was achieved without radical surgery, using voriconazole and terbinafine. Zusammenfassung Infektionen durch Scedosporium prolificans in immunkompetenten Wirten benötigen gewöhnlich zur Ausheilung ein ausgedehntes chirurgisches Debridement und manchmal sogar eine Amputation, bedingt durch die Resistenz dieses Erregers gegenüber bisher verfügbaren Antimykotika. Neuere Substanzen haben sich nicht als günstiger erwiesen. Itraconazol und Terbinafin in Kombination zeigen Synergismus gegenüber verschiedenen Fadenpilzen einschließlich S. prolificans. Wir berichten über eine orthopädische Infektion bei einem immunkompetenten Wirt durch S. prolificans, bei dem in vitro die Kombinationen Itraconazol plus Terbinafin und Voriconazol plus Terbinafin Synergismus zeigten. Ein Heilungserfolg wurde ohne radikale Chirurgie mit der Kombination Voriconazol plus Terbinafin erreicht.
ISSN:0933-7407
1439-0507
DOI:10.1046/j.1439-0507.2003.00878.x