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Cited by 67Antifungal resistance and susceptibilityHIV/AIDS oral health manifestationsOcular Infections and Treatments

A randomized trial of continuous or intermittent therapy with fluconazole for oropharyngeal candidiasis in HIV-infected patients: clinical outcomes and development of fluconazole resistance

Revankar, Sanjay G., Kirkpatrick, William R., McAtee, Robert K., Dib, Olga P., Fothergill, Annette W., Redding, Spencer W., Rinaldi, Michael G., Hilsenbeck, Susan G. +1 more·1998·The American Journal of Medicine
DOI 10.1016/s0002-9343(98)00137-5
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Abstract

Purpose The effects of continuous or intermittent therapy with fluconazole on the recurrence of and the development of fluconazole resistance are not known.Patients and methods We studied human immunodeficiency virus (HIV)-positive patients with CD4 cell count <350 x 10(6)/L and oropharyngeal candidiasis in a prospective, randomized study. After initial treatment, 20 patients (16 of whom completed 3 months of follow-up) received continuous fluconazole at 200 mg/day, and 48 patients (28 of whom completed follow-up) received intermittent therapy at the time of symptomatic relapses. Oral samples were obtained weekly during episodes of infection and quarterly as surveillance cultures. Development of resistance was defined as a fourfold rise in minimum inhibitory concentration (MIC) to at least 16 microg/mL from the initial culture in the same species, the emergence of new, resistant (MIC > or =16 microg/mL) species, or a significant increase in the proportion of resistant isolates.Results During a mean follow-up of 11 months, median annual relapse rates were lower in patients on continuous therapy (0 episodes/year) than in patients on intermittent therapy (4.1 episodes/year; P <0.001). Sterile cultures were seen in 6 of 16 (38%) patients on continuous therapy compared with 3 of 28 (11%) on intermittent therapy (P = 0.04). Microbiological resistance developed in 9 of 16 (56%) patients on continuous treatment, compared with 13 of 28 (46%) on intermittent treatment (P = 0.75). However, despite isolates with increased MICs, 42 of 44 patients responded to fluconazole in doses up to 800 mg/day.Conclusions In patients with frequent recurrences, continuous suppressive therapy significantly reduced relapses and colonization. Resistance occurred with both continuous and intermittent therapy; however, therapeutic responses were excellent.

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Crossref · 10.1016/s0002-9343(98)00137-5

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  • In the case of fluconazole, data for both human beings and animals suggest that S-DD isolates may be treated successfully with a dosage of 12 mg/kg per day.

    “In the case of fluconazole, data for both human beings and animals suggest that S-DD isolates may be treated successfully with a dosage of 12 mg/kg per day [30,32].”

    From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [32]

  • Long-term suppressive therapy with fluconazole is effective in prevention of oropharyngeal candidiasis in patients with AIDS and patients with cancer.

    “Long-term suppressive therapy with fluconazole is effective in the prevention of oropharyngeal candidiasis in patients with AIDS [32,[261][262][263] and patients with cancer [264].”

    From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [32]

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Authors
Revankar, S. G., Kirkpatrick, W. R., McAtee, R. K., Dib, O. P., Fothergill, A. W., Redding, S. W., Rinaldi, M. G., Hilsenbeck, S. G., & Patterson, T. F.
Affiliations
  • The University of Texas at San Antonio Health Science Center (US)
  • Audie L. Murphy Memorial VA Hospital (US)
Corresponding author
Revankar, Sanjay G.
ORCID
Venue
The American Journal of Medicine
Publisher
Elsevier BV
Published
1998-07
Volume
105
Issue
1
Pages
7-11
ISSN
0002-9343 (ISSN-L)
DOI
10.1016/s0002-9343(98)00137-5
OpenAlex
W2122973708
Cited by
67
References
30
Citations by year
2025: 2 · 2024: 1 · 2022: 2 · 2019: 1 · 2018: 2 · 2016: 1 · 2015: 1 · 2014: 1 · 2013: 1 · 2012: 4
FWCI
3.26
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The American Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute of Dental and Craniofacial Research (1R01 DE11381-01, R01DE011381)
  • National Center for Research Resources (M01RR01346, M01RR001346)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › HIV/AIDS oral health manifestations
  • Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
Keywords
fluconazole, oropharyngeal candidiasis, HIV infection, intermittent therapy, antifungal resistance, CD4 count, minimum inhibitory concentration
MeSH terms
Adult, Antifungal Agents, Candidiasis, Oral, Drug Resistance, Microbial, Female, Humans, Male, Oropharynx, Prospective Studies, Recurrence, Fluconazole, Treatment Outcome, AIDS-Related Opportunistic Infections

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