Clinical Uses

Ketoconazole remains useful in the treatment of cutaneous and mucous membrane dermatophyte and yeast infections, but it has been replaced by the newer tria-zoles in the treatment of most serious Candida infections and disseminated mycoses. Ketoconazole is usually effective in the treatment of thrush, but fluconazole is superior to ketoconazole for refractory thrush. Widespread dermatophyte infections on skin surfaces can be treated easily with oral ketoconazole when the use of topical antifungal agents would be impractical. Treatment of vulvovaginal candidiasis with topical imi-dazoles is less expensive.

Blastomycosis, histoplasmosis, sporotrichosis, paracoc-cidioidomycosis, and chromomycosis are better treated with itraconazole than ketoconazole, although ketocona-zole remains an alternative agent. Ketoconazole is ineffective in the treatment of cryptococcosis, aspergillosis, and mucormycosis. Candidemia is best treated with flu-conazole or amphotericin B.

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