Dermatologic Manifestations of Mycetoma Medication
- Author: Oliverio Welsh, MD DrSc; Chief Editor: Dirk M Elston, MD more...
Medication Summary
The goals of pharmacotherapy are to reduce morbidity, to prevent complications, and to eradicate the disease.
Antifungals
Class Summary
Ketoconazole, itraconazole, amphotericin B, and terbinafine are most commonly used to treat mycetoma. When systemic agents are administered, monitoring patients for adverse effects and complications common to the drug is important. Therapy is suggested for 1-2 years (or greater) for complete eradication, unless adverse effects warrant cessation of medication.
Ketoconazole (Nizoral)
Imidazole broad-spectrum antifungal agent; inhibits synthesis of ergosterol, causing cellular components to leak and resulting in fungal cell death. Available in 200-mg tablets.
Itraconazole (Sporanox)
Synthetic triazole antifungal agent that slows fungal cell growth by inhibiting cytochrome P-450–dependent synthesis of ergosterol, a vital component of fungal cell membranes. Available in 100-mg capsules.
Amphotericin B (AmBisome)
Produced by a strain of Streptomyces nodosus; can be fungistatic or fungicidal. Binds to sterols, such as ergosterol, in the fungal cell membrane, causing intracellular components to leak with subsequent fungal cell death.
Terbinafine (Lamisil)
Inhibits squalene epoxidase, which decreases ergosterol synthesis, causing fungal cell death. Use medication until symptoms significantly improve.
Antibiotics
Class Summary
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Trimethoprim and sulfamethoxazole (Bactrim, Bactrim DS, Septra, Septra DS)
Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. In certain anatomical sites (eg, thorax, head), extensive lesions, and cases recalcitrant to this antibiotic, add amikacin and maintain for 5-20 wk (or longer), depending on the clinical response and renal and auditory adverse effects.
Amikacin (Amikin)
Irreversibly binds to 30S subunit of bacterial ribosomes; blocks recognition step in protein synthesis; causes growth inhibition. Use the patient's IBW for dosage calculation. The current treatment of actinomycetoma is every 2 or 3 wk. Periodic audiometric and CrCl testing must be performed.
Netilmicin (Netromycin)
For gram-negative bacterial coverage of infections resistant to gentamicin. Irreversibly binds to 30S subunit of bacterial ribosomes; blocks recognition step in protein synthesis; causes growth inhibition.
Use IBW for dose calculation.
Minocycline (Dynacin, Minocin)
Treats infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma species.
Amoxicillin and clavulanate (Augmentin)
Drug combination treats bacteria resistant to beta-lactam antibiotics. Indicated for skin and skin structure infections caused by beta-lactamase–producing strains of Staphylococcus aureus. For children >3 mo, dose on amoxicillin content. Because of different amoxicillin/clavulanic acid ratios in 250-mg tab (250/125) vs 250-mg chewable tab (250/62.5), do not use 250-mg tab until a child weighs >40 kg.
Streptomycin
Aminoglycoside antibiotic recommended when less potentially hazardous therapeutic agents are ineffective or contraindicated.
Imipenem and cilastatin (Primaxin)
For treatment of multiple organism infections in which other agents do not have wide spectrum coverage or are contraindicated because of potential for toxicity.
Rifampin (Rifadin, Rimactane)
Inhibits DNA-dependent bacterial but not mammalian RNA polymerase. Supplied as 150- or 300-mg cap. Rifampin for injection USP contains rifampin 600 mg, sodium formaldehyde sulfoxylate 10 mg, and sodium hydroxide to adjust pH to 7.8-8.8. Rifampin for injection is for IV infusion only.
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| White grain | Black grain |
| Acremonium falciforme | Exophiala jeanselmei |
| Acremonium kiliense | Madurella grisea |
| Acremonium recifei | M mycetomatis |
| Cylindrocarpon destructans | M pseudomycetomatis |
| Fusarium moniliforme | Leptosphaeria tomkinsii |
| Fusarium solani | Leptosphaeria senegalensis |
| Neotestudina rosatii | Pyrenochaeta mackinnonii |
| Pseudallescheria boydii | Pyrenochaeta romeroi |
| ---------------- | Phlenodomus avramii |
| Etiologic agent | Grain |
| A madurae | White, large, 1-5 mm in diameter |
| A pelletieri | Red, hard, 1 mm in diameter |
| N brasiliensis | White to yellow, multilobed, soft, < 0.5 mm in diameter |
| N asteroides | Uncommon, white, soft, < 0.5 mm in diameter |
| Nocardia otitidiscaviarum | White to yellow, lobed, < 0.5 mm in diameter |
| Nocardia transvalensis | White to yellow, < 0.5 mm in diameter |
| Nocardia veterana[8] | -- |
| Nocardia mexicana[9] | -- |
| Nocardiopsis dassonvillei | White to yellow, < 0.5 mm in diameter |
| S somaliensis | Yellow, hard, 2 mm in diameter |
| Streptomyces sudanensis | Yellow, hard, 2 mm in diameter |
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