The treatment of this distressing and devastating disease is disappointing. The treatment depends mainly on its aetiological agent, the site and extent of the disease. Until recently, the only available treatment for mycetoma was amputation or multiple mutilating disfiguring surgical excisions. Combined medical treatment in the form of antifungals for the eumycetoma and antibiotics and antimicrobial agents for actinomycetoma and various surgical excisions is the gold standard in mycetoma.
The available treatment although not very effective, they are expensive and it may amount to more than US$3,000 per year per patient with eumycetoma. Most of the patients do not afford to have that and the drugs are not always available in endemic regions. The treatment is of a variable duration and may lapse for 2-3 years with a mean of 18 months
The therapeutic outcome of mycetoma depends on the bacterial or fungal aetiology of the infection, factors such as the infecting agent, the patient´s social and economic status, cultural background, nutrition, therapeutic compliance, resistance to previous therapies as well as the extension and location of the disease are also very important. Mycetoma is endemic in poor communities with few possibilities of maintaining prolonged therapy when medical support from a private or public organization is not provided.
As a neglected disease, mycetoma in general and fungal mycetoma in particular, has received little attention in the development of specific therapeutics. All currently used drugs against causative agents of eumycetoma were developed and studied with other more common fungi. For several decades, antifungal therapy has been limited to a few drugs that are toxic and delivered parenterally.