rifampin and Coccidioidomycosis

Topics: Antifungal Agents; Antitubercular Agents; Child; Coccidioidomycosis; Drug Therapy, Combination; Ethambutol; Fluconazole; Humans; Isoniazid; Liver Failure, Acute; Male; Pyrazinamide; Recovery of Function; Rifampin; Tuberculosis, Multidrug-Resistant

The use of endoscopic ultrasound in staging non-small cell lung cancer is well known. Its role in diagnosing non-malignant conditions that cause mediastinal adenopathy is still not well established. We diagnosed Coccidioides immitis and Mycobacterium tuberculosis in two patients using endoscopic ultrasound. To our knowledge this is the first case of Coccidioidomycosis to be diagnosed by endoscopic ultrasound.

Topics: Adult; Antibiotics, Antitubercular; Antifungal Agents; Antitubercular Agents; Coccidioides; Coccidioidomycosis; Endosonography; Ethambutol; Follow-Up Studies; Humans; Isoniazid; Itraconazole; Lymph Nodes; Male; Mycobacterium tuberculosis; Pyrazinamide; Rifampin; Time Factors; Treatment Outcome; Tuberculosis, Pulmonary

Amphotericin B, the principal drug used for treating systemic mycoses, possesses undesirable toxic properties. The ability of this antibiotic to potentiate antifungal activity of other compounds suggests that lower doses of amphotericin B could be used in combination with a second drug without loss of therapeutic efficacy. In vitro tests demonstrated that amphotericin B potentiated rifampin against the mycelial growth phase of Coccidioides immitis but not against the spherule-endospore phase. Therapy for murine coccidioidomycosis with a combined amphotericin B-rifampin regimen was not better than treatment with amphotericin B alone; in fact, combined drugs may have been even less effective. This would have clinical significance for therapy of concurrent infections.

Topics: Amphotericin B; Animals; Coccidioides; Coccidioidomycosis; Disease Models, Animal; Drug Synergism; Drug Therapy, Combination; Male; Mice; Rifampin