Itraconazole (Sporlab®) in the treatment of Penicillium marneffei infection in HIV-infected patients

Abstract

Penicillium marne.ffei is the most common cause of systemic fungal infection in HIV-infected patients in Thailand. Amphotericin B and itraconazole are the treatment of choice. Afterwards the patients must continue itraconazole for life to prevent a relapse. This research was a preliminary, opened-trial study to ® evaluate the effectiveness of  itraconazole  (Sporlab  ) in the treatment  of moderately  severe Penicillium marneffei infection in HIV-infected patients. The patients received Sporlab®( 100 mg) at a dose of 2 capsules 2 times daily after a meal for 8 weeks. Of 11 volunteers (5 male and 6 female), one female patient was excluded from the study in the 3rd week because of severe diarrhea. Of the IO volunteers, 9 had skin lesions that disappeared within an average of 18 days (10-28 days), 6 had fever that vanished within an average of 9 days (4-14 days), and in I patient presenting with abdominal pain, the investigation revealed hepatosplenomegaly and intraabdominal lymphadenopathy. The severity of the abdominal pain decreased after 2 weeks of treatment   and the discomfort had gone completely within 1 month, although abdominal ultrasonography showed no significant change. After the treatment, all 10 patients gained weight at an average of 2.56 kg/month (1-5 kg/month). No other adverse side effects were found, except in 1 patient, who had elevated liver enzymes that became normal in the follow up of the secondary prophylaxis. In conclusion, this preliminary, opened-trial study found that Sporlab®is effective in the treatment of moderately severe Penicillium marneffei infection in HIV-infected patients . The treatment does not warrant hospitalization and the cost is much lower than that for standard remedies.