The objective of this study is to evaluate the efficacy and tolerability of posaconazole compared to itraconazole for treatment of histoplasmosis.
We conducted a retrospective review of patients who were treated for histoplasmosis between January 2006 and December 2015 at SIU School of Medicine, Infectious Diseases Clinic. All patients 18 years and older with a diagnosis of histoplasmosis and treated with posaconazole were included and compared with a similar group of patients who received itraconazole therapy. The two groups were compared using Chi-square test for categorical variables and Student’s T-test for continuous variables. Outcome data were analyzed using logistic regression analysis and odds ratio (OR) were calculated.
We reviewed records of 30 patients with appropriate clinical and radiological findings and a confirmed diagnosis of histoplasmosis by one or more methods including tissue biopsy (73%), culture and serology. Twenty five patients (83%) had pulmonary histoplasmosis and five (17%) had disseminated infection. Only 2 patients in the posaconazole and 3 in the itraconazole group were immunosuppressed. The baseline data were similar between the two groups. Of the 15 patients who were treated with posaconazole, 10 (67%) had complete resolution, 2 stopped due to side effects including rash and leg cramps, 1 stopped due to insurance denial, and 2 were lost to follow. In the itraconazole group (N=15), 13 (87%) had complete resolution, none of the patients stopped due to side effects, and 2 were lost to follow. However, one patient in the itraconazole group and none in the posaconazole group had recurrence after stopping the antifungal. There was no statistically significant difference between the two groups in the treatment outcomes (OR 3.25, p=0.4) or adverse events (p>0.05). Median duration of treatment with posaconazole was 6 months (Interquartile ranges, 2-12 months) which was shorter compared to itraconazole (median 10 months, IQR 6-12 months). However, this was not statistically significant (p=0.07) due to small sample size.
This study confirms that posaconazole is a reasonable alternative to itraconazole for treatment of patients with histoplasmosis. This is the largest series of data comparing posaconazole and itraconazole for the treatment of histoplasmosis.
V. Sundareshan, None
V. Prakash, None
I. Tyagi, None
S. Waqar, None
S. Bergman, None
J. Koirala, None