Serum itraconazole concentrations and clinical responses in Candida-associated denture stomatitis patients treated with itraconazole solution and itraconazole capsules

Abstract

The aim of this study was to compare the concentrations of itraconazole in serum and saliva after treatment with itraconazole cyclodextrin solution or itraconazole capsules in Candida-associated denture stomatitis patients without evidence of immunodeficiency. Forty patients were randomly assigned to receive either itraconazole cyclodextrin solution or itraconazole capsules, both at a dosage of 100 mg bd for 15 days. On completion of treatment palatal erythema was assessed and an oral rinse and imprint cultures were collected. Serum and saliva samples were collected at the same time and itraconazole concentrations measured using reverse-phase high-performance liquid chromatography. Itraconazole susceptibilities of Candida albicans and Candida glabrata strains isolated at baseline were measured by a broth microdilution method. Serum itraconazole concentrations achieved did not differ significantly between the two preparations (P = 0.39) although a significantly higher number of patients in the itraconazole cyclodextrin group (P < 0.001) had detectable levels of itraconazole in their saliva compared with the capsule group. Mycologically cured patients had slightly, though not significantly (P = 0.28), higher serum itraconazole concentrations than those from whom yeasts were not eradicated. It was concluded that both formulations of itraconazole were equally effective in treatment of denture stomatitis. Among immunocompetent patients, the absorption of the liquid preparation is no greater than that of the capsules. Therapeutic success in this group was achieved with lower serum itraconazole concentrations than have been reported for immunocompromised groups.

Oropharyngeal Candidiasis in Patients with Human Immunodeficiency Virus: Correlation of Clinical Outcome with In Vitro Resistance, Serum Azole Levels, and Immunosuppression

“…We used serum levels of azole as an estimate of levels in the oropharynx. Previous studies found that levels in saliva were similar or higher than corresponding values in serum [22,23]. It is uncertain whether a peak or a trough level is the most important predictor of outcome.…”

Interventions for the Management of Denture Stomatitis: A Systematic Review and Meta‐Analysis

“…Of the 35 included trials, 11 did not have data to be entered in the meta‐analysis because they presented the results only in figures or graphs or because the data were not usable for statistical analysis …”

“…The duration of the intervention in the majority of the studies was 14 to 15 days. 13,14,[16][17][18]22,[24][25][26][27]31,[35][36][37][38][39]42,43,45,46 Some were 7 to 8 days, 15,32,40,47 and the rest were longer than 15 days, with a maximum of 90 days. 11,12,20,21,23,[28][29][30]33,34,41,44 One study used a single application of the intervention.…”

Antifungal Drug Therapeutic Monitoring: What are the Issues?

“…Studies examining the use of itraconazole for prophylaxis of invasive fungal infections in neutropenic patients have associated concentrations of 0.25-0.5 mg/L with efficacy [21][22][23]. Concentration breakpoints established as potential targets for successful treatment of invasive fungal infection range from 5 to 6.5 mg/L when measured by bioassay and 0.6-1 mg/L when measured by HPLC [19,[24][25][26][27][28]. There are a number of limitations associated with interpreting results of these studies, as they are retrospective, include a small number of patients, do not have standardized reasons or timing for obtaining concentrations, and are not designed to establish an ideal concentration target.…”