Itraconazole versus ketaconazole in the treatment of oral and oesophageal candidosis in patients infected with HIV

Smith, Don; Midgley, J.; Allan, M. W. B.; Connolly, G M; Gazzard, Brian

doi:10.1097/00002030-199111000-00014

Cited by 59 publications

(31 citation statements)

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“…This study con firms previous reports [2,16] that itracon azole is an effective agent in oral candidiasis and provides additional data on the use of itraconazole in this therapeutic area.…”

Section: Discussionsupporting

confidence: 91%

“…Advantages over kétoconazole appear to be its lower incidence of hcpatotoxic side-effects, longer half-life (20 h) and enhanced lipophilicity achieving tissue concentrations up to 20 times that of plasma [1]. In a trial comparing itraconazole 200 mg/day versus kctoconazole 400 mg/day for 4 weeks, equivalent clinical cures and relapse rates in oropharyngeal and esophageal candidiasis were observed [ 16],…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Itraconazole and Ketoconazole in HIV-Positive Patients with Oropharyngeal or Esophageal Candidiasis

Repentigny

Ratelle²

1996

Chemotherapy

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The efficacy of oral itraconazole and ketoconazole in the treatment of oropharyngeal and/or esophageal candidiasis, and the rate of post-treatment relapse, were compared in a multicenter, prospective, double-blind, double-dummy, randomized, parallel-group trial. A total of 143 adult HIV-positive patients with oropharyngeal and/or esophageal candidiasis were assigned to receive either itraconazole or ketoconazole (200 mg/day). Patients with oropharyngeal and esophageal candidiasis were treated for 2 and 4 weeks, respectively. Patients were evaluated clinically and mycologically after 1, 2 and 4 (for esophageal patients) weeks of therapy, and relapses were compared in a 6-week post-treatment follow-up period. Of 129 evaluable patients, 98 had oropharyngeal candidiasis and 31 esophageal infection. CDC classification, CD4+ cell counts, and number of previous episodes of oropharyngeal or esophageal candidiasis were comparable in both groups. Oropharyngeal infection was cleared clinically at 21 days in 71 % of patients receiving itraconazole and 60% receiving ketoconazole, and esophageal candidiasis was cleared at 41 days in 100% of patients receiving itraconazole and 91 % receiving ketoconazole. Marginally significant differences were found between itraconazole and ketoconazole in rates of clearing of infection clinically in patients with oropharyngeal and esophageal candidiasis (p = 0.0614 and 0.0781, respectively). Mean rates of infection relapse were not statistically different in the two treatment groups. Adverse events were generally mild and not considered drug related. Itraconazole is marginally more efficacious than ketoconazole in the treatment of oropharyngeal and esophageal candidiasis in HIV-positive patients and both drugs appear safe and well tolerated.

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“…This study con firms previous reports [2,16] that itracon azole is an effective agent in oral candidiasis and provides additional data on the use of itraconazole in this therapeutic area.…”

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Comparison of Itraconazole and Ketoconazole in HIV-Positive Patients with Oropharyngeal or Esophageal Candidiasis

Repentigny

Ratelle²

1996

Chemotherapy

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“…Among the 33 patients who did not respond to itraconazole oral solution, the baseline organisms included C. albicans (32), C. glabrata (10), and C. krusei (1). The 48-hr itraconazole MIC ranged from 0.06 to 2.0 m g/ml.…”

Section: Efficacymentioning

confidence: 99%

“…10 The response to itraconazole has been less than that observed with fluconazole, most likely owing to the poor absorption of the capsule formulation. 1 1,12 Because of the variable absorption of the capsule form ulation, a liquid formulation of itraconazole was developed.…”

Section: Introduction O R O P H a R Y N G Ea L C A N D Id Ia S Is (Thmentioning

confidence: 99%

Treatment of Fluconazole-Refractory Oropharyngeal Candidiasis with Itraconazole Oral Solution in HIV-Positive Patients

Saag

Fessel²,

Kaufman³

et al. 1999

AIDS Research and Human Retroviruses

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This open-label, multicenter trial evaluated the efficacy and safety of a new oral solution formulation of itraconazole in HIV+/AIDS patients with fluconazole-refractory oropharyngeal candidiasis. Seventy-four HIV+/AIDS patients with mycologically confirmed oropharyngeal candidiasis who failed fluconazole therapy (200 mg/day) were treated with 100 mg of itraconazole oral solution administered twice daily (200 mg/day) for 14 days. Patients who demonstrated an incomplete response to treatment were treated for an additional 14 days (28 days total). Clinical responders were eligible for participation in a separate 6-month maintenance protocol. If they declined further treatment, responders were monitored for 6 weeks posttreatment. The primary efficacy parameter was clinical response (i.e., no lesions or symptoms) at end of treatment. Fungal cultures were performed at baseline and at the end of treatment. Among the 74 patients who had mycologically confirmed, fluconazole-unresponsive, oropharyngeal candidiasis at baseline, 41 (55%) achieved a clinical response by day 28. The median time to response was 7 days (range, 7 to 28 days). Candida albicans was the most common pathogen isolated, either alone (62%) or in combination with another Candida species (31%). All 22 patients who entered the optional, off-therapy, 6-week follow-up phase relapsed; mean time to relapse was 13 days. Itraconazole oral solution was well-tolerated; adverse events were predominantly gastrointestinal disturbances. This trial demonstrates that itraconazole oral solution is a useful therapy in the treatment of HIV-infected patients with fluconazole-refractory oropharyngeal candidiasis.

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“…21 In a prospective randomized trial, Laine and colleagues 21 compared ketoconazole 200 mg/day to¯uconazole 100 mg/day in 143 patients with AIDS and oesophageal candidiasis. 23 Another study 24 found greater endoscopic cure at 3 weeks (75% vs. 38%) with¯uconazole 100 mg b.d. compared to itraconazole 100 mg b.d., although no differences in short-term clinical remission (78% vs. 73%) were demonstrated.…”

Section: 10±12mentioning

confidence: 99%

The therapy of gastrointestinal infections associated with the acquired immunodeficiency syndrome

Wilcox

Mönkemüller

1997

Aliment Pharmacol Ther

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Although there have been dramatic strides in the therapy of human immunodeficiency virus infection over the last few years, the number of infected people world‐wide is tremendous and, at least in developing countries, continues to expand. Complications which involve the gastrointestinal tract are common in these patients, because the gut is a major site for involvement by opportunistic infections and neoplasms in patients with the acquired immunodeficiency syndrome. It is important to recognize the clinical spectrum of gastrointestinal diseases, as well as the appropriate and most cost‐effective diagnostic strategies, as therapies for a number of these disorders are both widely available and highly effective. This review summarizes the major gastrointestinal infections which are seen in patients with the acquired immunodeficiency syndrome, and their treatment.

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Itraconazole versus ketaconazole in the treatment of oral and oesophageal candidosis in patients infected with HIV

Cited by 59 publications

References 0 publications

Comparison of Itraconazole and Ketoconazole in HIV-Positive Patients with Oropharyngeal or Esophageal Candidiasis

Comparison of Itraconazole and Ketoconazole in HIV-Positive Patients with Oropharyngeal or Esophageal Candidiasis

Treatment of Fluconazole-Refractory Oropharyngeal Candidiasis with Itraconazole Oral Solution in HIV-Positive Patients

The therapy of gastrointestinal infections associated with the acquired immunodeficiency syndrome

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