Comparison of fluconazole and itraconazole for treatment of rhinomaxillary mucormycosis

摘要

Ama?: ?al??mam?z?n amac?, rhinomaksiler mukormikoz (RMM) tedavisi i?in Fluconazole - Itraconazole uygulamas?n? kar??la?t?rmakt?r. Y?ntemler: Ba? ve boyun b?lgesinde osteomiyelit ile etkilenen hastalar?n demografik, klinik, radyolojik ve histopatolojik verilerini ald?k ve sadece RMM'den etkilenen 33 hasta b?lümsel kay?tlardan ayr?ld?. Cinsiyet, ya?, diyabetik durum, komorbidite gibi ?e?itli ?zellikler kaydedildi. Hastalar, kendilerine verilen azol ilac? a??s?ndan rastgele iki gruba ayr?ld?. A grubuna Flukonazol, B grubuna Itrakonazol verildi. Antifungal ilac?n birlikte kullan?lmas? ile yap?lan agresif cerrahi, tüm hastalarda zorunlu tedavi idi. ?la?lar?n yan etkilerinin düzenli olarak izlenmesi ve tekrarlama uzun süre takip edildi. Bulgular: Toplamda 18 hasta erkek, 15 hasta kad?nd? (E/K 1,2). Hastalar?n ya? ortalamas? 48.21 (11,66), ya?lar? 25 ile 70 aras?nda de?i?mekteydi. 33 hastan?n 30'u (%90,9) diyabetikti. Grup A'da 15 hasta Fluconazole ile tedavi edilirken, grup B'de 18 hasta Itraconazole ile tedavi edildi. Kemik nekrozu d???nda her iki grupta da sunulan klinik belirti ve semptomlar?n ?o?unda p0.05 düzeyinde istatistiksel olarak anlaml? bir fark bulunmad? (P=0.381). Grup A'da 4 hastada nüks g?rüldü (%26,6), grup B'de ise 5 hastada (%27,7) nüks saptand? (p=0,943). Sonu?: Destekleyici antifungal ila?lar ile birlikte agresif cerrahi yakla??m tedavinin dayanak noktas? olarak kald?. Flukonazol ve Itrakonazol aras?nda anlaml? bir fark g?zlenmedi. Aim: Rhinomaxillary mucormycosis (RMM) is a detrimental and progressive deep fungal infection which predominantly affects immunocompromised patients. The disease has heterogeneity in clinical manifestation and presents with unfavorable consequences. Despite recent advances in the diagnosis and treatment, the disease has inadequate prognosis overall. The aim of our study is to compare Fluconazole vs. Itraconazole for the management of RMM. Methods: We retrieved demographic, clinical, radiological and histopathological data of patients affected with osteomyelitis in head and neck region and 33 patients exclusively affected with RMM were separated from departmental records. Several characteristics such as Gender, age, Diabetic status, co-morbidity were observed. Patients were randomly distributed in two groups with respect to the azole drug prescribed to them. Group A was given Fluconazole while group B was given Itraconazole. Aggressive surgery with concomitant use of antifungal drug was the mandatory treatment in all patients. Regular monitoring of side effects of drugs and recurrence was carried out for prolonged time. Results: Overall, 18 patients were male and 15 patients were female with a ratio of M:F 1.2. Mean age of patients was 48.21 (11.66) with the age range from 25 years to 70 years. Out of 33 patients, 30 of the patients (90.9%) were diabetic. Fifteen patients in Group A were managed with Fluconazole while 18 patients in group B were treated with Itraconazole. There was no statistically significant difference observed in most of the clinical signs and symptoms presented in both groups as p0.05 except for bone necrosis (P=0.381). In group A, 4 patients exhibited recurrence (26.6%) while in group B, 5 (27.7%) patients presented with recurrence (p=0.943). Conclusion: Aggressive surgical approach along with supportive antifungal medication remained the mainstay of the treatment. Between Fluconazole and Itraconazole there was no difference observed.