PARADOXICAL RESPONSE TO ITRACONAZOLE TREATMENT IN A PATIENT WITH ONYCHOMYCOSIS CAUSED BY MICROSPORUM-GYPSEUM

A Columbian patient presented with a rare type of onychomycosis caused by Microsporum gypseum. Oral treatment with itraconazole formulation (Funazol(R)) available in Columbia failed to improve the nail alterati on. The fungitoxic effect of itraconazole was assessed on the M. gypse um strain cultured from the nail of the patient by using the method of culture of fungi on cyanoacrylate skin surface strippings (CSSS). In addition, a comparative evaluation of the oral bioavailability of itra conazole was made in volunteers after intake of Funazol(R) and Sporano x(R). In the ex vivo bioassay on CSSS, topical itraconazole proved to be highly active against M. gypseum. After oral intake, however, the i traconazole bioavailability of Funazol(R) relative to Sporanox(R) aver aged only 3.5%. Antifungal pulse therapy with Sporanox(R) 400 daily fo r 1 week per month for 4 months, cured the patient. This study shows t hat itraconazole is hardly or not absorbed from the oral formulation F unazol(R). Both the oral bioavailability and consequently therapeutic efficacy of the genuine drug (Sporanox(R) are highly superior.