Subject(s)
Creatine Kinase/standards , Autoanalysis/methods , Heart Diseases/enzymology , Humans , Isoenzymes , Quality ControlABSTRACT
A 2.5 kg thoracopagus (Siamese) twin and a 0.73 kg premature newborn developed systemic candidiasis and were treated with intravenous miconazole. The conjoined twin was in a state of severe metabolic acidosis, respiratory distress, jaundice, anuria, abdominal distension, and shock. The 0.73 kg premature infant was also in a state of severe metabolic acidosis, respiratory distress, and oliguria. Miconazole was used in this desperate situation for the treatment of life-threatening candidiasis. Both infants responded well to treatment and recovered. All parameters of their diseases improved during therapy despite pre-existing multiple organ dysfunction. Miconazole can be a safe alternative to amphotericin B for the treatment of systemic candidiasis in neonatal infants, including those with impaired renal function.
Subject(s)
Candidiasis/drug therapy , Imidazoles/administration & dosage , Infant, Premature, Diseases/drug therapy , Miconazole/administration & dosage , Sepsis/drug therapy , Candida albicans , Humans , Infant , Infant, Newborn , Infant, Premature, Diseases/etiology , Male , Sepsis/etiology , Twins, ConjoinedABSTRACT
A simple, reliable, and inexpensive assay for quantitation of the imidazole drugs miconazole, RV 40,500, and RV 41,400 was tested. The assay, similar to a Kirby-Bauer test, was sensitive to less than or equal to 0.2 mug of drug per ml and linear from less than or equal to 0.2 to 10.0 mug/ml. Concentration of inoculum and agar depth in test plates was not as critical as the type of medium, amount of inoculum, or type of drug used.
Subject(s)
Imidazoles/blood , Animals , Horses , Humans , Methods , Microbial Sensitivity Tests/methodsABSTRACT
Eight patients with fungal meningitis (5 with the coccidioidal type, 2 with cryptococcal, and 1 with histoplasmosis) were treated with intravenous (IV) and intrathecal (IT) miconazole after previous therapy with amphotericin B proved unsuccessful. Miconazole was well tolerated with both IV and IT administration. The CSF concentration of miconazole one hour after an IV infusion of 800 mg was 0.1 to 0.3 microgram/ml. When 20 mg of miconazole was administered intrathecally via lumbar injection in patients with coccidioidal meningitis, 6.5, 2.4, 0.77, and 0.24 microgram/ml, respectively, was found in the CSF at the cisternal level at 12, 24, 48, and 72 hours, respectively. Miconazole is apparently an effective fungistatic drug of low toxicity and is a potentially useful agent in the treatment of systemic mycoses and fungal meningitis, in particular.
Subject(s)
Imidazoles/therapeutic use , Meningitis/drug therapy , Miconazole/therapeutic use , Mycoses/drug therapy , Adult , Aged , Arachnoiditis/etiology , Cerebral Hemorrhage/etiology , Cisterna Magna , Coccidioidomycosis/drug therapy , Cryptococcosis/drug therapy , Histoplasmosis/drug therapy , Humans , Injections, Intravenous , Injections, Spinal/adverse effects , Male , Miconazole/administration & dosage , Miconazole/adverse effects , Middle AgedABSTRACT
Ten patients with systemic mycoses, including five with fungal meningitis, were treated with intravenously or intrathecally administered miconazole, or both. Minimal inhibitory concentrations of miconazole for clinical isolates of Coccidioides immitis, Cryptococcus neoformans and Candida albicans were less than 0.6 microg per ml. Except for pruritus of variable degrees, the drug was well tolerated both intravenously and intrathecally by all patients. No measurable impairment of renal, hepatic or bone marrow function was observed in patients after 4(1/2) months of intravenous therapy. No hematological or biochemical abnormalities and no evidence of recurrent coccidioidal osteomyelitis were observed in 16 months of follow-up in our first patient treated with this drug. Miconazole is apparently an effective antifungal drug of low toxicity and is a potentially useful agent for treatment of human systemic mycoses.