Outros antifúngicos azólicos
Há experiência clínica crescente e relatos de caso de tratamento bem-sucedido da blastomicose com outros antifúngicos azólicos (por exemplo, voriconazol, posaconazol).[2]Thompson GR 3rd, Le T, Chindamporn A, et al. Global guideline for the diagnosis and management of the endemic mycoses: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology. Lancet Infect Dis. 2021 Dec;21(12):e364-e374.
http://www.ncbi.nlm.nih.gov/pubmed/34364529?tool=bestpractice.com
[4]Linder KA, Kauffman CA, Miceli MH. Blastomycosis: a review of mycological and clinical aspects. J Fungi (Basel). 2023 Jan 14;9(1):117.
https://www.mdpi.com/2309-608X/9/1/117
http://www.ncbi.nlm.nih.gov/pubmed/36675937?tool=bestpractice.com
[44]Ta M, Flowers SA, Rogers PD. The role of voriconazole in the treatment of central nervous system blastomycosis. Ann Pharmacother. 2009 Oct;43(10):1696-700.
http://www.ncbi.nlm.nih.gov/pubmed/19724015?tool=bestpractice.com
[45]Freifeld A, Proia L, Andes D, et al. Voriconazole use for endemic fungal infections. Antimicrob Agents Chemother. 2009 Apr;53(4):1648-51.
http://www.ncbi.nlm.nih.gov/pubmed/19139290?tool=bestpractice.com
[46]Bariola JR, Perry P, Pappas PG, et al. Blastomycosis of the central nervous system: a multicenter review of diagnosis and treatment in the modern era. Clin Infect Dis. 2010 Mar 15;50(6):797-804.
http://www.ncbi.nlm.nih.gov/pubmed/20166817?tool=bestpractice.com
No entanto, grandes ensaios clínicos prospectivos não foram concluídos. O isavuconazol demonstrou atividade in vitro contra a Blastomyces dermatitidis, mas o uso clínico relatado nesse contexto é limitado.[47]Yamazaki T, Inagaki Y, Fujii T, et al. In vitro activity of isavuconazole against 140 reference fungal strains and 165 clinically isolated yeasts from Japan. Int J Antimicrob Agents. 2010 Oct;36(4):324-31.
http://www.ncbi.nlm.nih.gov/pubmed/20674282?tool=bestpractice.com
[48]Thompson GR 3rd, Rendon A, Ribeiro Dos Santos R, et al. Isavuconazole treatment of cryptococcosis and dimorphic mycoses. Clin Infect Dis. 2016 Aug 1;63(3):356-62.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4946023
http://www.ncbi.nlm.nih.gov/pubmed/27169478?tool=bestpractice.com
[49]Scolarici MJ, King C, Sterkel A, et al. The role of Isavuconazonium Sulphate for the treatment of blastomycosis: a case series and antifungal susceptibility. Open Forum Infect Dis. 2022 Jul;9(7):ofac220.
https://www.doi.org/10.1093/ofid/ofac220
http://www.ncbi.nlm.nih.gov/pubmed/35821730?tool=bestpractice.com
O isavuconazol é aprovado em alguns países para o tratamento de adultos com aspergilose invasiva e mucormicose.