Itraconazole or Amphotericin B for Talaromycosis

Abstract

Le et al. (June 15 issue)¹ report that amphotericin B was superior to itraconazole in the treatment of talaromycosis and that the rates of adverse events were higher with amphotericin B use. However, some issues need to be discussed. The investigators did not report severity of illness or preexisting medical conditions. The treatment of talaromycosis depends on the severity of the infection, because itraconazole is recommended for milder forms of talaromycosis and amphotericin B or voriconazole for more severe forms.² The efficacy of treatment in both study groups can be misleading if, for instance, patients were not adequately treated or were overtreated on the basis of the severity of their infection. The presence of preexisting medical conditions could influence treatment outcomes, because patients with these conditions may be more susceptible to negative outcomes.