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Thrush Can Be Prevented in Patients With Acquired Immunodeficiency Syndrome and the Acquired Immunodeficiency Syndrome—Related Complex: Randomized, Double-blind, Placebo-Controlled study of 100-mg Oral Fluconazole Daily

Thrush Can Be Prevented in Patients With Acquired Immunodeficiency Syndrome and the Acquired... Abstract Recurrent oropharyngeal candidiasis is common in patients with acquired immunodeficiency syndrome and the acquired immunodeficiency syndrome—related complex. It causes local pain and discomfort, loss of taste, and aversion to food and may lead to secondary complications. We examined, in a double-blind study, whether recurrent thrush could be prevented by prophylaxis. Twenty-five patients with one to four previous thrush episodes who had no thrush at the outset of the study were randomized to receive 100 mg of fluconazole or placebo daily for 12 weeks. If thrush occurred, prophylaxis was stopped and patients were treated conventionally, after which prophylaxis was resumed. After the randomized study, some patients were given continuous fluconazole (open phase). In the randomized study, thrush occurred in eight of 13 placebo-treated patients and none of 12 fluconazole-treated patients. possible side effects were not different between the groups. Dermatophytosis and onychomycosis and cryptococcuria also improved in the fluconazole-treated patients, and fungal colonization was significantly decreased. One episode of thrush occurred in the open phase in an intermittently compliant patient (group total, 71.5 patient-months of fluconazole treatment); in contrast, the 25 patients also had had two episodes of Candida esophagitis, three of cryptococcosis, and 13 of dermatophytosis before entry. Subsequent to entry in the randomized trial, in 92.3 patientmonths without fluconazole, there were 35 episodes of thrush, one of esophagitis, one of cryptococcemia, and one of dermatophytosis, and preexisting dermatophytosis and onychomycosis were unchanged or worsened. Individual patients observed with and without fluconazole treatment also showed its efficacy. In conclusion, thrush can be prevented in patients with acquired immunodeficiency syndrome and the acquired immunodeficiency syndrome— related complex with negligible toxic effects. Larger trials to confirm prevention of all mycoses with prophylaxis should be considered. (Arch Intern Med. 1991;151:2458-2464) References 1. Stevens DA. Fungal infections in AIDS patients . Br J Clin Pract. 1990;44( (suppl 71) ):11-22. 2. DeWit S, Weerts D, Goossens H, Clumeck N. Comparison of fluconazole and ketaconazole for oropharyngeal candidiasis in AIDS . Lancet. 1989;1:746-747.Crossref 3. Hay RJ. Overview of studies Of fluconazole in oropharyngeal candidiasis . Rev Infect Dis. 1990;12( (suppl 3) ):S334-S337.Crossref 4. Dupont B, Drouhet E. Fluconazole in the management of oropharyngeal candidosis in a predominantly HIV antibodypositive group of patients . J Med Vet Mycol. 1988;26:67-71.Crossref 5. Wright CD, Bowie JU, Gray GR, Nelson RD. Candidacidal activity of myeloperoxidase: mechanisms of inhibitory influence of soluble cell wall mannan . Infect Immun. 1983;42:76-80. 6. Domer JE, Stashak PW, Elkins K, Prescott B, Caldes G, Baker PJ. Separation of immunomodulatory effects of mannan from Candida albicans into stimulatory and suppressive components . Cell Immunol. 1986;101:403-414.Crossref 7. Bye MR, Palamba A, Bernstein L, Shah K. Clinical Candida supraglottitis in an infant with AIDS-related complex . Pediatr Pulmonol. 1987;3:280-281.Crossref 8. Radin DR, Fong T-L, Halls JM, Pontrelli GN. Monilia enteritis in acquired immunodeficiency syndrome . AJR Am J Roentgenol. 1983;141:1289-1290.Crossref 9. Rhoads JL, Wright DC, Redfield RR, Burke DS. Chronic vaginal candidiasis in women with human immunodeficiency virus infection . JAMA. 1987;256:3105-3107.Crossref 10. Stevens DA. The new generation of antifungal drugs . Eur J Clin Microbiol Infect Dis. 1988;7:732-735.Crossref 11. Rogers TE, Galgiani JN. Fluconazole (UK-49, 858) and Ketaconazole activity against Candida albicans in vitro and in vivo . Antimicrob Agents Chemother. 1986;30:418-422.Crossref 12. Troke PF, Andrews RJ, Brammer KW, Marriott MS, Richardson K. Efficacy of UK-49, 858 (fluconazole) against Candida albicans experimental infections in mice . Antimicrob Agents Chemother. 1985;28:815-818.Crossref 13. Perfect JR, Savani DV, Durack DT. Comparison of itraconazole and fluconazole in treatment of cryptococcal meningifts and Candida pyelonephritis in rabbits . Antimicrob Agents Chemother. 1986;29:579-583.Crossref 14. Chave JP, Cajot A, Bille J, Glauser MP. Single-dose therapy of oral candidiasis with fluconazole in HIV-infected adults: a pilot study . J infect Dis. 1989;159:806-807.Crossref 15. Centers for Disease Control. Revision of CDC surveillance case definition for the acquired immunodeficiency syndrome . MMWR. 1987;36:1S-15S. 16. Scherer S, Stevens DA. Application of DNA typing methods to epidemiology and taxonomy of Candida species . J Clin Microbiol. 1987;25:675-679. 17. Cox FW, Stiller RL, South DA, Stevens DA. Oral Ketoconazole for dermatophyte infections . J Am Acad Dermatol. 1982;6:455-462.Crossref 18. Ajello L, Padhye AA. Dermatophytes and the agents of superficial mycoses . In: Lennette EH, Balows A, Hausler WJ, Shadomy HJ, eds. Manual of Clinical Microbiology. 4th ed. Washington, DC: American Society for Microbiology; 1985:514-525. 19. Faergemann J, Fredriksson T. Experimental infections in rabbits and humans with Pityrosporum orbiculare and Pityrosporum ovale . J Invest Dermatol. 1981;77:314-318.Crossref 20. Bozzette SA, Larsen R, Chiu J, et al. Successful Secondary prophylaxis of cryptococcal meningitis with fluconazole: a placebo-controlled trial . In: Program and abstracts of the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy, Atlanta, 1990 . Abstract 1161. 21. Ford GP, Farr PM, Ive FA, Shuster S. The response of Seborrhoeic dermatitis to ketoconazole . Br J Dermatol. 1984;111:603-607.Crossref 22. Ryley JF, Wilson RG, Barrett-Bee KJ. Azole resistance in Candida albicans . Sabouraudia. 1984;22:53-63.Crossref 23. Johnson EM, Richardson MD, Warnock DW. In vitro resistance to imidazole antifungals in Candida albicans . J Antimicrob Chemother. 1984;13:547-558.Crossref 24. Smith KJ, Warnock DW, Kennedy CTC, Johnson EM, Hopwood V, Van Cutsem J, Vanden Bossche H. Azole resistance in Candida albicans . J Med Vet Mycol. 1986;24:133-144.Crossref 25. Yamaguchi H. Antagonistic action of lipid components of membranes from Candida albicans and various other lipids on two imidazole antimycotics, clotrimazole and miconazole . Antimicrob Agents Chemother. 1977;12:16-25.Crossref 26. Vanden Bossche H, Willemsens G, Cools W, Lauwers WFJ, Le Jeune L. Biochemical effects of miconazole on fungi, II: inhibition of ergosterol biosynthesis in Candida albicans . Chem Biol Interactions. 1978;21:59-78.Crossref 27. Beggs WH, Andrews FA, Sarosi GA. Action of imidazolecontaining antifungal drugs . Life Sci. 1981;28:111-118.Crossref 28. Lazar JD, Wilner KD. Drug interactions with fluconazole . Rev Infect Dis. 1990;12( (suppl 3) ):S327-S333.Crossref 29. Stevens DA. Problems in antifungal chemotherapy . Infection. 1987;15:87-92.Crossref 30. Samonis G, Rolston K, Karl C, Miller P, Bodey GP. Prophylaxis of oropharyngeal candidiasis with fluconazole . Rev Infect Dis. 1990;12( (suppl 3) ):S369-S373.Crossref 31. Leen CLS, Dunbar EM, Ellis ME, Mandal BK. Once-weekly fluconazole to prevent recurrence of oropharyngeal candidiasis in patients with AIDS and AIDS-related complex: a doubleblind placebo-controlled study . J Infection. 1990;21:55-60.Crossref 32. Lavilla Paz GA, Valencia ME, Pintado V, Dupla JML, Puig JG. Fluconazole preventive therapy for Candida esophagitis in AIDS . In: Program and abstracts of the Sixth International Conference on AIDS; 1990 . Abstract ThB 466. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Thrush Can Be Prevented in Patients With Acquired Immunodeficiency Syndrome and the Acquired Immunodeficiency Syndrome—Related Complex: Randomized, Double-blind, Placebo-Controlled study of 100-mg Oral Fluconazole Daily

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References (33)

Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400120096018
Publisher site
See Article on Publisher Site

Abstract

Abstract Recurrent oropharyngeal candidiasis is common in patients with acquired immunodeficiency syndrome and the acquired immunodeficiency syndrome—related complex. It causes local pain and discomfort, loss of taste, and aversion to food and may lead to secondary complications. We examined, in a double-blind study, whether recurrent thrush could be prevented by prophylaxis. Twenty-five patients with one to four previous thrush episodes who had no thrush at the outset of the study were randomized to receive 100 mg of fluconazole or placebo daily for 12 weeks. If thrush occurred, prophylaxis was stopped and patients were treated conventionally, after which prophylaxis was resumed. After the randomized study, some patients were given continuous fluconazole (open phase). In the randomized study, thrush occurred in eight of 13 placebo-treated patients and none of 12 fluconazole-treated patients. possible side effects were not different between the groups. Dermatophytosis and onychomycosis and cryptococcuria also improved in the fluconazole-treated patients, and fungal colonization was significantly decreased. One episode of thrush occurred in the open phase in an intermittently compliant patient (group total, 71.5 patient-months of fluconazole treatment); in contrast, the 25 patients also had had two episodes of Candida esophagitis, three of cryptococcosis, and 13 of dermatophytosis before entry. Subsequent to entry in the randomized trial, in 92.3 patientmonths without fluconazole, there were 35 episodes of thrush, one of esophagitis, one of cryptococcemia, and one of dermatophytosis, and preexisting dermatophytosis and onychomycosis were unchanged or worsened. Individual patients observed with and without fluconazole treatment also showed its efficacy. In conclusion, thrush can be prevented in patients with acquired immunodeficiency syndrome and the acquired immunodeficiency syndrome— related complex with negligible toxic effects. Larger trials to confirm prevention of all mycoses with prophylaxis should be considered. (Arch Intern Med. 1991;151:2458-2464) References 1. Stevens DA. Fungal infections in AIDS patients . Br J Clin Pract. 1990;44( (suppl 71) ):11-22. 2. DeWit S, Weerts D, Goossens H, Clumeck N. Comparison of fluconazole and ketaconazole for oropharyngeal candidiasis in AIDS . Lancet. 1989;1:746-747.Crossref 3. Hay RJ. Overview of studies Of fluconazole in oropharyngeal candidiasis . Rev Infect Dis. 1990;12( (suppl 3) ):S334-S337.Crossref 4. Dupont B, Drouhet E. Fluconazole in the management of oropharyngeal candidosis in a predominantly HIV antibodypositive group of patients . J Med Vet Mycol. 1988;26:67-71.Crossref 5. Wright CD, Bowie JU, Gray GR, Nelson RD. Candidacidal activity of myeloperoxidase: mechanisms of inhibitory influence of soluble cell wall mannan . Infect Immun. 1983;42:76-80. 6. Domer JE, Stashak PW, Elkins K, Prescott B, Caldes G, Baker PJ. Separation of immunomodulatory effects of mannan from Candida albicans into stimulatory and suppressive components . Cell Immunol. 1986;101:403-414.Crossref 7. Bye MR, Palamba A, Bernstein L, Shah K. Clinical Candida supraglottitis in an infant with AIDS-related complex . Pediatr Pulmonol. 1987;3:280-281.Crossref 8. Radin DR, Fong T-L, Halls JM, Pontrelli GN. Monilia enteritis in acquired immunodeficiency syndrome . AJR Am J Roentgenol. 1983;141:1289-1290.Crossref 9. Rhoads JL, Wright DC, Redfield RR, Burke DS. Chronic vaginal candidiasis in women with human immunodeficiency virus infection . JAMA. 1987;256:3105-3107.Crossref 10. Stevens DA. The new generation of antifungal drugs . Eur J Clin Microbiol Infect Dis. 1988;7:732-735.Crossref 11. Rogers TE, Galgiani JN. Fluconazole (UK-49, 858) and Ketaconazole activity against Candida albicans in vitro and in vivo . Antimicrob Agents Chemother. 1986;30:418-422.Crossref 12. Troke PF, Andrews RJ, Brammer KW, Marriott MS, Richardson K. Efficacy of UK-49, 858 (fluconazole) against Candida albicans experimental infections in mice . Antimicrob Agents Chemother. 1985;28:815-818.Crossref 13. Perfect JR, Savani DV, Durack DT. Comparison of itraconazole and fluconazole in treatment of cryptococcal meningifts and Candida pyelonephritis in rabbits . Antimicrob Agents Chemother. 1986;29:579-583.Crossref 14. Chave JP, Cajot A, Bille J, Glauser MP. Single-dose therapy of oral candidiasis with fluconazole in HIV-infected adults: a pilot study . J infect Dis. 1989;159:806-807.Crossref 15. Centers for Disease Control. Revision of CDC surveillance case definition for the acquired immunodeficiency syndrome . MMWR. 1987;36:1S-15S. 16. Scherer S, Stevens DA. Application of DNA typing methods to epidemiology and taxonomy of Candida species . J Clin Microbiol. 1987;25:675-679. 17. Cox FW, Stiller RL, South DA, Stevens DA. Oral Ketoconazole for dermatophyte infections . J Am Acad Dermatol. 1982;6:455-462.Crossref 18. Ajello L, Padhye AA. Dermatophytes and the agents of superficial mycoses . In: Lennette EH, Balows A, Hausler WJ, Shadomy HJ, eds. Manual of Clinical Microbiology. 4th ed. Washington, DC: American Society for Microbiology; 1985:514-525. 19. Faergemann J, Fredriksson T. Experimental infections in rabbits and humans with Pityrosporum orbiculare and Pityrosporum ovale . J Invest Dermatol. 1981;77:314-318.Crossref 20. Bozzette SA, Larsen R, Chiu J, et al. Successful Secondary prophylaxis of cryptococcal meningitis with fluconazole: a placebo-controlled trial . In: Program and abstracts of the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy, Atlanta, 1990 . Abstract 1161. 21. Ford GP, Farr PM, Ive FA, Shuster S. The response of Seborrhoeic dermatitis to ketoconazole . Br J Dermatol. 1984;111:603-607.Crossref 22. Ryley JF, Wilson RG, Barrett-Bee KJ. Azole resistance in Candida albicans . Sabouraudia. 1984;22:53-63.Crossref 23. Johnson EM, Richardson MD, Warnock DW. In vitro resistance to imidazole antifungals in Candida albicans . J Antimicrob Chemother. 1984;13:547-558.Crossref 24. Smith KJ, Warnock DW, Kennedy CTC, Johnson EM, Hopwood V, Van Cutsem J, Vanden Bossche H. Azole resistance in Candida albicans . J Med Vet Mycol. 1986;24:133-144.Crossref 25. Yamaguchi H. Antagonistic action of lipid components of membranes from Candida albicans and various other lipids on two imidazole antimycotics, clotrimazole and miconazole . Antimicrob Agents Chemother. 1977;12:16-25.Crossref 26. Vanden Bossche H, Willemsens G, Cools W, Lauwers WFJ, Le Jeune L. Biochemical effects of miconazole on fungi, II: inhibition of ergosterol biosynthesis in Candida albicans . Chem Biol Interactions. 1978;21:59-78.Crossref 27. Beggs WH, Andrews FA, Sarosi GA. Action of imidazolecontaining antifungal drugs . Life Sci. 1981;28:111-118.Crossref 28. Lazar JD, Wilner KD. Drug interactions with fluconazole . Rev Infect Dis. 1990;12( (suppl 3) ):S327-S333.Crossref 29. Stevens DA. Problems in antifungal chemotherapy . Infection. 1987;15:87-92.Crossref 30. Samonis G, Rolston K, Karl C, Miller P, Bodey GP. Prophylaxis of oropharyngeal candidiasis with fluconazole . Rev Infect Dis. 1990;12( (suppl 3) ):S369-S373.Crossref 31. Leen CLS, Dunbar EM, Ellis ME, Mandal BK. Once-weekly fluconazole to prevent recurrence of oropharyngeal candidiasis in patients with AIDS and AIDS-related complex: a doubleblind placebo-controlled study . J Infection. 1990;21:55-60.Crossref 32. Lavilla Paz GA, Valencia ME, Pintado V, Dupla JML, Puig JG. Fluconazole preventive therapy for Candida esophagitis in AIDS . In: Program and abstracts of the Sixth International Conference on AIDS; 1990 . Abstract ThB 466.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Dec 1, 1991

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