Fluconazole Suspension for Oropharyngeal Candidiasis Unresponsive to Tablets

Martins, Marcelo D.; Rex, John H.

doi:10.7326/0003-4819-126-4-199702150-00020

Cited by 27 publications

(9 citation statements)

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“…Over time, especially with repeated courses of fluconazole therapy in patients with CD4 lymphocyte counts below 50/mm 3 (19,28,34,43), favorable treatment responses become less likely (14,18,22,24,29,33,35,38). Approaches to recalcitrant infections have included escalating the dose of fluconazole (36,37,38), using intravenous instead of oral administration (36), switching to another member of the azole class (7,32,39), adding topical antifungal agents (7,9,21,26,27,39,41,42) . In this context, the echinocandins provide a new class of antifungal agents that uniquely inhibit the synthesis of cell wall glucans critical to the integrity of many yeasts and molds (3).…”

Section: Discussionmentioning

confidence: 99%

Randomized, Double-Blind, Multicenter Study of Caspofungin versus Amphotericin B for Treatment of Oropharyngeal and Esophageal Candidiases

Arathoon

Gotuzzo

Noriega

et al. 2002

Antimicrob Agents Chemother

247

156

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Caspofungin is an antifungal agent of the novel echinocandin class. We investigated its efficacy, safety, and tolerability as therapy for oropharyngeal and/or esophageal candidiasis in a phase II dose-ranging study. Patients were randomized in a double-blind manner to receive either caspofungin acetate (35, 50, or 70 mg) or amphotericin B (0.5 mg/kg of body weight) intravenously once daily for 7 to 14 days. A favorable response required both complete resolution of symptoms and quantifiable improvement of mucosal lesions 3 to 4 days after discontinuation of study drug. Efficacy was assessed using a modified intent-to-treat analysis. No hypothesis testing of efficacy was planned or performed. Of 140 enrolled patients, 63% had esophageal involvement and 98% were infected with the human immunodeficiency virus (HIV) (median CD4 count, 30/mm 3 ). A modestly higher proportion of patients in each of the caspofungin groups (74 to 91%) achieved favorable responses compared to amphotericin B recipients (63%), but there was considerable overlap in the 95% confidence intervals surrounding these point estimates. Similar trends were found in the subgroups with esophageal involvement, a history of fluconazole failure, and CD4 counts of <50/mm 3 . A smaller proportion of patients receiving any dose of caspofungin experienced drug-related adverse events compared to patients given standard doses of conventional amphotericin B (P < 0.01). Caspofungin provided a generally well-tolerated parenteral therapeutic option for HIV-infected patients with oropharyngeal and/or esophageal candidiasis in this study.Mucosal candidiasis, although not life-threatening, causes significant morbidity in patients infected with the human immunodeficiency virus (HIV) (16). The development of drug resistance in the causative strain or the selection of intrinsically more resistant species may complicate therapy of recurrent candidal infections (19,20,28,34,36,40,43). This study describes the use of a new echinocandin, caspofungin (Cancidas; formerly MK-0991), as treatment for oropharyngeal and esophageal candidiasis in an immunocompromised patient population.Oral fluconazole is widely regarded as the treatment of choice for mucosal candidiasis under most circumstances (36). Amphotericin B deoxycholate has been the standard recourse for patients infected with Candida sp. unresponsive to azole therapy (5,10,24,36). The use of conventional amphotericin B preparations is complicated by its significant toxicity. Newer lipid formulations of amphotericin have reduced, but not eliminated, some of these adverse effects (15).Caspofungin possesses activity in vitro (6,17,23,30,31,42) and in vivo (1, 2, 11, 13) against a variety of fungal pathogens, including Candida and Aspergillus species. Echinocandins noncompetitively inhibit 1,3-␤-D-glucan synthesis, interfering with the normal formation of the fungal cell wall (3). Since glucans are not present in mammalian cells, it is hoped that echinocandins will have a relatively high therapeutic index. Crossresistance with...

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Section: Discussionmentioning

confidence: 99%

Randomized, Double-Blind, Multicenter Study of Caspofungin versus Amphotericin B for Treatment of Oropharyngeal and Esophageal Candidiases

Arathoon

Gotuzzo

Noriega

et al. 2002

Antimicrob Agents Chemother

247

156

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“…(g) Treatment of fluconazole-resistant candidosis Management strategies for fluconazole-resistant cases include: (a) higher oral doses of fluconazole, up to 600 mg per day; (b) use of a fluconazole suspension as an oral rinse (Martins and Rex, 1997); and (c) the use of systemic ketoconazole 400 mg per day or itraconazole 200-400 mg per day (Ng and Denning, 1993). Several reports indicate that itraconazole is an effective alternative for fluconazole-resistant candidosis (Dupont et al, 1996;Phillips et al, 1996;Cartledge et al, 1997).…”

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confidence: 99%

Oral Candidal Infections and Antimycotics

Ellepola

Samaranayake

2000

Critical Reviews in Oral Biology & Medicine

210

236

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The advent of the human immunodeficiency virus infection and the increasing prevalence of compromised individuals in the community due to modern therapeutic advances have resulted in a resurgence of opportunistic infections, including oral candidoses. One form of the latter presents classically as a white lesion of "thrush" and is usually easily diagnosed and cured. Nonetheless, a minority of these lesions appears in new guises such as erythematous candidosis, thereby confounding the unwary clinician and complicating its management. Despite the availability of several effective antimycotics for the treatment of oral candidoses, failure of therapy is not uncommon due to the unique environment of the oral cavity, where the flushing effect of saliva and the cleansing action of the oral musculature tend to reduce the drug concentration to sub-therapeutic levels. This problem has been partly circumvented by the introduction of the triazole agents, which initially appeared to be highly effective. However, an alarming increase of organisms resistant to the triazoles has been reported recently. In this review, an overview of clinical manifestations of oral candidoses and recent advances in antimycotic therapy is given, together with newer concepts, such as the post-antifungal effect (PAFE) and its possible therapeutic implications.

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“…Fluconazole in the form of suspension and with different dosages has been used for the treatment of oropharyngeal candidiasis. The theoretical benefit of using topical fluconazole is that a higher concentration of the active drug is delivered to the oral mucosa without the untoward systemic side effects [23], [24]. However, most of the participants recommended capsule form of fluconazole 91% whereas only 9% of the respondents suggested oral suspension form of the drug.…”

Section: Discussionmentioning

confidence: 84%

Current Antifungal Drug Prescribing to Treat Oral Thrush in Sulaimani City-Iraq

Rsaul

2018

UHD J SCI TECH

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Oral thrush or oral candidosis is one of the most widespread fungal infections of the mucous membranes in human. This study aims to evaluate the pattern of prescribing of three antifungal drugs: nystatin, amphotericin B, fluconazole, and miconazole by the pharmacists and assistant pharmacists, which are used to treat oral thrush. A questionnaire was circulated to a random selection of pharmacies in Sulaimani city of Iraq between March 2017 and June 2017 and responses to were received from 101 pharmacies. The results were analyzed and the responses demonstrated as absolute and relative frequencies using Statistical Package for the Social Sciences Program (SPSS) version 21. Among the participants (65.3%) were males and (34.7%) were females. The participant's age range was (20 – 70) years. The majority (52.3%) holds a postgraduate degree as their highest educational level and they graduated after 2010. Miconazole and nystatin were the most popular choices of an antifungal agent that pharmacists would use, followed by fluconazole and amphotericin-B. The possibility of using miconazole was positively linked to recently graduated participants.

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Fluconazole Suspension for Oropharyngeal Candidiasis Unresponsive to Tablets

Cited by 27 publications

References 0 publications

Randomized, Double-Blind, Multicenter Study of Caspofungin versus Amphotericin B for Treatment of Oropharyngeal and Esophageal Candidiases

Randomized, Double-Blind, Multicenter Study of Caspofungin versus Amphotericin B for Treatment of Oropharyngeal and Esophageal Candidiases

Oral Candidal Infections and Antimycotics

Current Antifungal Drug Prescribing to Treat Oral Thrush in Sulaimani City-Iraq

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