Publication: Improved Survival in Vascular Pythiosis With Surgery and Azithromycin, Doxycycline, and Itraconazole Therapy: A Phase II Multicenter, Open-Label, Single-Arm Trial
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Issued Date
2025-06-15
Resource Type
ISSN
10584838
eISSN
15376591
Scopus ID
2-s2.0-105011244537
Pubmed ID
39932261
Journal Title
Clinical Infectious Diseases
Volume
80
Issue
6
Start Page
1281
End Page
1289
Rights Holder(s)
SCOPUS
Bibliographic Citation
Clinical Infectious Diseases Vol.80 No.6 (2025) , 1281-1289
Suggested Citation
Torvorapanit P., Worasilchai N., Manothummetha K., Srisurapanont K., Thongkam A., Langsiri N., Leksuwankun S., Meejun T., Thanakitcharu J., Lerttiendamrong B., Susaengrat N., Chuleerarux N., Siriyakorn N., Watcharasuwanseree S., Suparatanachatpun P., Chayangsu S., Khemla S., Kajeekul R., Wattanasoontornsakul W., Bansong R., Sakulkonkij P., Wongkamhla T., Diewsurin J., Laohasakprasit K., Kongsakpaisal P., Chayapum P., Chindamporn A., Plongla R., Permpalung N. Improved Survival in Vascular Pythiosis With Surgery and Azithromycin, Doxycycline, and Itraconazole Therapy: A Phase II Multicenter, Open-Label, Single-Arm Trial. Clinical Infectious Diseases Vol.80 No.6 (2025) , 1281-1289. 1289. doi:10.1093/cid/ciaf062 Retrieved from: https://hdl.handle.net/20.500.14740/21213
Author(s)
Torvorapanit P.
Worasilchai N.
Manothummetha K.
Srisurapanont K.
Thongkam A.
Langsiri N.
Leksuwankun S.
Meejun T.
Thanakitcharu J.
Lerttiendamrong B.
Susaengrat N.
Chuleerarux N.
Siriyakorn N.
Watcharasuwanseree S.
Suparatanachatpun P.
Chayangsu S.
Khemla S.
Kajeekul R.
Wattanasoontornsakul W.
Bansong R.
Sakulkonkij P.
Wongkamhla T.
Diewsurin J.
Laohasakprasit K.
Kongsakpaisal P.
Chayapum P.
Chindamporn A.
Plongla R.
Permpalung N.
Worasilchai N.
Manothummetha K.
Srisurapanont K.
Thongkam A.
Langsiri N.
Leksuwankun S.
Meejun T.
Thanakitcharu J.
Lerttiendamrong B.
Susaengrat N.
Chuleerarux N.
Siriyakorn N.
Watcharasuwanseree S.
Suparatanachatpun P.
Chayangsu S.
Khemla S.
Kajeekul R.
Wattanasoontornsakul W.
Bansong R.
Sakulkonkij P.
Wongkamhla T.
Diewsurin J.
Laohasakprasit K.
Kongsakpaisal P.
Chayapum P.
Chindamporn A.
Plongla R.
Permpalung N.
Author's Affiliation
Johns Hopkins University School of Medicine
Chulalongkorn University
Siriraj Hospital
Faculty of Medicine, Chiang Mai University
Srinakharinwirot University
King Chulalongkorn Memorial Hospital
Jackson Memorial Hospital
Faculty of Medicine, Chulalongkorn University
Rajavithi Hospital
Maharaj Nakhon Ratchasima Hospital
Lampang Hospital
Buddhachinaraj Hospital
Sunpasitthiprasong Hospital
Surin Hospital
Sawanpracharak Hospital
Udon Thani Center Hospital
Nan Hospital
Nakhon Pathom Hospital
Paholpolpayuhasena Hospital
Nakhon Phanom Hospital
Khonkaen Hospital
Chulalongkorn University
Siriraj Hospital
Faculty of Medicine, Chiang Mai University
Srinakharinwirot University
King Chulalongkorn Memorial Hospital
Jackson Memorial Hospital
Faculty of Medicine, Chulalongkorn University
Rajavithi Hospital
Maharaj Nakhon Ratchasima Hospital
Lampang Hospital
Buddhachinaraj Hospital
Sunpasitthiprasong Hospital
Surin Hospital
Sawanpracharak Hospital
Udon Thani Center Hospital
Nan Hospital
Nakhon Pathom Hospital
Paholpolpayuhasena Hospital
Nakhon Phanom Hospital
Khonkaen Hospital
Corresponding Author(s)
Other Contributor(s)
Abstract
Background Vascular pythiosis, caused by Pythium insidiosum, is a life-threatening disease with high mortality rate in patients with residual disease post-surgery. This study evaluated the effectiveness of a combination therapy of surgery, azithromycin, doxycycline, and itraconazole. Methods In this open-label, Phase II multicenter trial, 51 patients were enrolled. Patients were categorized based on residual disease post-surgery (unresectable lesions, incomplete resection, or persistent symptoms). Patients with residual disease received azithromycin (500 mg daily), doxycycline (100 mg twice daily), and itraconazole (200 mg thrice daily) until beta-d-glucan (BDG) levels were negative (<80 pg/mL) for 3 months. Those without residual disease received the same regimen for 6 months. Outcomes included all-cause mortality at 6 months, adverse events, changes in BDG levels over time, and factors associated with residual disease and mortality. Results At 6 months, the all-cause mortality rate was 15.7%. Mortality in patients with residual disease was 31.5% compared to 6.25% for those without (P =. 04). Lesions above the popliteal artery were a significant predictor of residual disease (incidence rate ratio [IRR] 3.20, 95% confidence interval [CI]: 1.08-11.70). BDG levels decreased over time (odds ratio [OR] 0.82, 95% CI:. 77-.88 per week, P <. 001) but remained higher in the residual disease group (OR 4.29, 95% CI: 1.55-11.92) Conclusions The combination therapy of surgery, azithromycin, doxycycline, and itraconazole improves survival in patients with vascular pythiosis, including those with residual disease. This regimen is well tolerated and should be considered a standard of care, with further research needed for long-term outcomes.