A comparison of the efficacy of itraconazole, amphotericin B and 5-fluorocytosine in the treatment of Aspergillus fumigatus endocarditis in the rabbit.

The efficacy of amphotericin B, 5-fluorocytosine and itraconazole was compared for the treatment of experimental rabbit Aspergillus fumigatus endocarditis. Therapy with amphotericin B or 5-fluorocytosine, at dosages of 3.0 and 35 mg/kg body weight respectively, failed to eradicate aspergillus from the cardiac vegetations in all but one of the animals tested; none of these animals survived for longer than nine treatment days. When similar doses of amphotericin and 5-fluorocytosine were administered concomittantly, 30% of the animals had sterile vegetations. Itraconazole at 2.5 and 3.5 mg/kg body weight was not successful; all the animals tested had infected vegetations and did not survive beyond nine days of therapy. In contrast, itraconazole at 5.0 mg/kg sterilised the endocardial vegetations and all these animals survived for 14 days. It is concluded that itraconazole may be useful in the treatment of aspergillus endocarditis.