+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Itraconazole cyclodextrin solution for fluconazole-refractory oropharyngeal candidiasis in AIDS: correlation of clinical response with in vitro susceptibility



Itraconazole cyclodextrin solution for fluconazole-refractory oropharyngeal candidiasis in AIDS: correlation of clinical response with in vitro susceptibility



Aids 10(12): 1369-1376



Objective: To evaluate the efficacy of itraconazole cyclodextrin solution in fluconazole-refractory oropharyngeal candidiasis (OPC), and to correlate clinical outcome with in vitro susceptibility and serum azole levels. Design: A prospective, open-label, intervention study. Setting: A university hospital, which serves as the provincial HIV referral center. Patients and interventions: Thirty-six HIV-infected individuals referred for fluconazole-refractory OPC were evaluated prospectively between May 1993 and March 1995, including clinical assessment, serum azole levels, and susceptibility testing of Candida spp. isolates. Itraconazole solution was administered orally at a daily dose of 200 mg for 14 days, followed by suppressive therapy. Thirty-four patients were evaluable. Main outcome measure: Resolution of oral pseudomembranous lesions. Results: Initial isolates were Candida albicans (n = 33), C. glabrata (n = 1), C. krusei (n = 1), and mixed infection with C. albicans and C. krusei (n = 1). Fluconazole serum levels obtained at the time of failed therapy ranged from 4.7 to 40 mg/l (median, 12.9 mg/l). Itraconazole was generally well tolerated. Clinical responses were observed in 65% (22 out of 34) of evaluable cases. Among the responders, relapse had occurred within 2 months for four (36%) out of 11 cases who continued with followup. The median fluconazole minimal inhibitory concentration (MIC) was 64 mg/l for isolates from fluconazole-refractory cases, compared with a median of 0.5 mg/l for control isolates (P = 0.002). The median itraconazole MIC for isolates from fluconazole-refractory cases was 1.25 mg/l, compared with a median of 0.078 mg/l for controls (P = 0.011). Conclusion: A correlation between clinical response and in vitro susceptibility was clearly demonstrated for fluconazole, but not for itraconazole. Itraconazole cyclodextrin solution may be effective for fluconazole-refractory OPC and should be considered prior to salvage therapy with intravenous amphotericin B.

(PDF emailed within 0-6 h: $19.90)

Accession: 008930773

Download citation: RISBibTeXText

PMID: 8902066

DOI: 10.1097/00002030-199610000-00009


Related references

Itraconazole solution for fluconazole-refractory oropharyngeal candidiasis in AIDS Correlation of clinical response with in vitro susceptibility. TENTH INTERNATIONAL CONFERENCE ON AIDS, INTERNATIONAL CONFERENCE ON STD Tenth International Conference on AIDS and the International Conference on STD, Vol 2; The global challenge of AIDS: Together for the future : 2) 23, 1994

Correlation of in vitro susceptibility testing with clinical outcome in fluconazole-treated AIDS patients with oropharyngeal candidiasis. Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 36(0): 90, 1996

Treatment of fluconazole-refractory oropharyngeal candidiasis with itraconazole oral solution in HIV-positive patients. Aids Research and Human Retroviruses 15(16): 1413-1417, 1999

Correlation of in vitro itraconazole and fluconazole susceptibility with clinical outcome for patients with vulvovaginal candidiasis. Mycopathologia 157(1): 43-47, 2004

Correlation of in vitro fluconazole susceptibility with clinical outcome for severely ill patients with oropharyngeal candidiasis. Clinical Infectious Diseases 26(4): 903-908, 1998

A double-blind comparison of itraconazole oral solution and fluconazole capsules for the treatment of oropharyngeal candidiasis in patients with AIDS. Clinical Infectious Diseases 26(6): 1368-1373, 1998

A Double-Blind Comparison of Itraconazole Oral Solution and Fluconazole Capsules for the Treatment of Oropharyngeal Candidiasis in Patients with Aids. Clinical Infectious Diseases 26(6): 1368-1373, 1998

Itraconazole cyclodextrin solution: the role of in vitro susceptibility testing in predicting successful treatment of HIV-related fluconazole-resistant and fluconazole-susceptible oral candidosis. Aids 11(2): 163-168, 1997

Itraconazole oral solution versus fluconazole treatment of oropharyngeal candidiasis. Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 35(0): 244, 1995

Correlation between in vitro susceptibility of Candida albicans and fluconazole-resistant oropharyngeal candidiasis in HIV-infected patients. European Journal of Clinical Microbiology and Infectious Diseases 12(12): 911-915, 1993

Correlation between in vitro susceptibility ofCandida albicansand fluconazole-resistant oropharyngeal candidiasis in HIV-infected patients. European Journal of Clinical Microbiology & Infectious Diseases 12(12): 911-915, 1993

Efficacy of Alcohol-Based and Alcohol-Free Melaleuca Oral Solution for the Treatment of Fluconazole-Refractory Oropharyngeal Candidiasis in Patients with Aids. Hiv Clinical Trials 3(5): 379-385, 2002

Efficacy of alcohol-based and alcohol-free melaleuca oral solution for the treatment of fluconazole-refractory oropharyngeal candidiasis in patients with AIDS. HIV Clinical Trials 3(5): 379-385, 2002

Fluconazole for Refractory Oropharyngeal Candidiasis in AIDS Patients. Aids Patient Care 9(2): 56-59, 1995

Resistance of Candida albicans to fluconazole during treatment of oropharyngeal candidiasis in a patient with AIDS: documentation by in vitro susceptibility testing and DNA subtype analysis. Clinical Infectious Diseases 18(2): 240-242, 1994