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Clinical Evaluation and Microbiology of Oropharyngeal Infection Due to Fluconazole‐Resistant Candida in Human Immunodeficiency Virus–Infected Patients

1998; Oxford University Press; Volume: 26; Issue: 4 Linguagem: Inglês

10.1086/513950

1537-6591

Sanjay G. Revankar, Olga P. Dib, William R. Kirkpatrick, Robert K. McAtee, Annette W. Fothergill, Michael G. Rinaldi, Spencer W. Redding, Thomas F. Patterson,

Antifungal resistance and susceptibility

Signs and symptoms of oropharyngeal candidiasis (OPC) were correlated with microbiology and clinical response to fluconazole in a cohort of patients with advanced human immunodeficiency virus (HIV) infection and recurrent OPC. Sixty-four HIV-infected patients with a median CD4 cell count of <50/mm3 (range, 3–318/mm3) who presented with OPC were enrolled in a longitudinal study. Specimens for cultures were taken weekly until clinical resolution. Therapy with fluconazole was increased weekly as required to a maximum daily dose of 800 mg until resolution of symptoms and oral lesions. Resistant or dose-dependent susceptible yeasts, defined as a minimum inhibitory concentration of ⩾16 µg/mL, were detected in 48 (31%) of 155 episodes. Clinical resolution with fluconazole therapy occurred in 107 (100%) of 107 episodes with susceptible yeasts vs. 44 (92%) of 48 episodes with resistant or dose-dependent susceptible strains (P = .008). Patients from whom fluconazole-resistant yeasts were isolated required longer courses of therapy and higher doses of fluconazole for response, but overall, excellent responses to fluconazole were seen in patients with advanced HIV infection.