Interventions for the prevention and management of oropharyngeal candidiasis associated with HIV infection in adults and children

Abstract

Five new studies were added to the review, but their results do not alter the final conclusion of the review.Implications for practice Due to there being only one study in children, it is not possible to make recommendations for treatment or prevention of OC in children. Amongst adults, there were few studies per comparison. Due to insufficient evidence, no conclusion could be made about the effectiveness of clotrimazole, nystatin, amphotericin B, itraconazole or ketoconazole with regard to OC prophylaxis. In comparison to placebo, fluconazole is an effective preventative intervention. However, the potential for resistant Candida organisms to develop, as well as the cost of prophylaxis, might impact the feasibility of implementation. No studies were found comparing fluconazole with other interventions. The direction of findings suggests that ketoconazole, fluconazole, itraconazole and clotrimazole improved the treatment outcomes.Implications for research It is encouraging that low-cost alternatives are being tested, but more research needs to be on in this area and on interventions like gentian violet and other less expensive anti-fungal drugs to treat OC. More well-designed treatment trials with larger samples are needed to allow for sufficient power to detect differences in not only clinical, but also mycological, response and relapse rates. There is also a strong need for more research to be done on the treatment and prevention of OC in children as it is reported that OC is the most frequent fungal infection in children and adolescents who are HIV positive. More research on the effectiveness of less expensive interventions also needs to be done in resource-poor settings. Currently few trials report outcomes related to quality of life, nutrition, or survival. Future researchers should consider measuring these when planning trials. Development of resistance remains under-studied and more work must be done in this area. It is recommended that trials be more standardised and conform more closely to CONSORT.

Antifungal activity of miconazole against recent Candida strains

“…Based on a recent survey conducted by the AIDS Clinical Trials Group, the most common antifungal agents used to treat OPC are CLO, NYS and FLU. 8,9 Although FLU has proven to be very effective in treating OPC, resistance to this antifungal has been reported. Further, certain non-albicans species are innately less susceptible to FLU, such as C. glabrata and C. krusei, and these are being recovered more frequently from HIV patients.…”

SIOP PODC: Recommendations for supportive care of children with cancer in a low‐income setting

“…Adequate pain control is important. For local mouth care, an antiseptic solution such as gentian violet (0.25%) assists with healing [44][45][46]. A local anesthetic spray is particularly useful for children with painful oral ulcerations who will not drink or eat.…”

Taiwanofungus camphoratus (Syn Antrodia camphorata) Extract and Amphotericin B Exert Adjuvant Effects via Mitochondrial Apoptotic Pathway

“…The heptaene macrolide amphotericin B (AmB) is a broadspectrum fungistatic and fungicidal drug that has been used for more than 50 years 1 to treat systemic fungal infections of immune-compromised hosts, such as patients with leukemia, 2 AIDS, 3 and organ transplantation candidates. 4 AmB interacts specifically with ergosterol-containing membranes and forms micelles.…”