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- Title
Predicting a therapeutic cut‐off serum level of itraconazole in recalcitrant tinea corporis and cruris—A prospective trial.
- Authors
Khurana, Ananta; Agarwal, Aastha; Singh, Ashutosh; Sardana, Kabir; Ghadlinge, Manik; Agrawal, Diksha; Panesar, Sanjeet; Sethia, Khushboo; Chowdhary, Anuradha
- Abstract
Background: With rising resistance to terbinafine, and consistently high MICs to fluconazole and griseofulvin, itraconazole is being increasingly used as a first line drug for tinea corporis/cruris. However, inadequate clinical responses are often seen with it in spite of in vitro susceptibility. This is possibly related to a variable pharmacokinetic profile of itraconazole. The drug serum levels associated with the therapeutic outcome have not been defined in dermatophytic infections. Methods: Forty treatment naïve patients with tinea corporis/cruris were randomised to one of the three dose groups (100, 200 and 400 mg/day) of itraconazole. The drug serum levels of 21 of these patients were obtained after 2 weeks of treatment and correlated with the final clinical outcome and in vitro antifungal susceptibility data. Results: Trichophyton indotineae was identified by sequencing of ITS region of rDNA and TEF1α. All isolates were sensitive to itraconazole (Minimum Inhibitory Concentration (MICs) range: 0.06–0.5 µg/ml), while MICs to terbinafine were uniformly high (range 8–32 µg/ml). Thirty‐seven patients (92.5%) achieved complete cure, while three failed treatment. Serum levels achieved with 400 mg/day were significantly higher than levels with 100 or 200 mg dose. All patients with itraconazole serum levels of >0.2 µg/ml were cured, while two out of the 10 patients with serum levels <0.2 µg/ml failed treatment. Conclusions: Therapeutic failures are uncommon with itraconazole, and the prevalent strain in India has low itraconazole MICs. Treatment failure is likely with itraconazole serum levels of <0.2 µg/ml, while levels >0.2 µg/ml are consistently associated with a positive therapeutic outcome.
- Subjects
INDIA; RINGWORM; ITRACONAZOLE; TREATMENT failure; TERBINAFINE; TREATMENT effectiveness
- Publication
Mycoses, 2021, Vol 64, Issue 12, p1480
- ISSN
0933-7407
- Publication type
Article
- DOI
10.1111/myc.13367