Reports of thrush clinically refractory to azoles in AIDS patients are increasing with the more widespread use of these agents. We studied our own oral preparation of amphotericin B in the treatment of two AIDS patients who developed oral thrush due to Candida glabrata after prolonged fluconazole use. Improvement occurred in both in less than 1 week, with eventual clearing and absence of side effects. Oral amphotericin B may have advantages over alternatives for this increasing problem.Systemic amphotericin B (AraB) has been regarded as the standard therapy for deep fungal infections. Because of greatly reduced toxicity, ease of administration and demonstrated efficacy, the use of oral azoles in AIDS patients, particularly fluconazole, for the treatment of oral thrush, candidal oesophagitis or cryptococcosis, or for secondary prophylaxis of thrush or cryptococcal meningitis, is widespread [19]. In other settings of common fluconazole use, the appearance of resistant isolates has been described [37]. Reports of oral thrush in AIDS patients clinically refractory to azoles, caused by isolates resistant to azoles in vitro, are now increasing [12,15,26]. The main alternatives for treatment of these cases each have drawbacks. Oral nystatin, for example, is a potential problem because of its unpleasant bitter taste, which reduces compliance; side effects of nausea, vomiting and diarrhoea [20]; disappointing results [6]; and reports of development of resistance [1,3,22]. Flucytosine is a problem because of native resistance [33] and the potential for resistance development and side effects [31], in particular hepatotoxicity and myelosuppression, which are especially difficult to evaluate in AIDS patients. Parenteral AraB is usually not beneficial in thrush, owing to its sub-therapeutic concentration in saliva [8]. No oral preparation of AmB is commercially available in the USA or many other countries, and where available, AmB preparations have produced variable responses [2,3,8,11,17,24,25]. We therefore studied the efficacy and tolerance of our own oral AmB preparation in some cases of azole-resistant thrush.
Case 1A 25-year-old male AIDS patient had been taking oral fluconazole, 200 mg daily, for over 8 months as maintenance therapy for cryptococcosis, when he developed