Once-weekly fluconazole to prevent recurrence of oropharyngeal candidiasis in patients with AIDS and AIDS-related complex: A double-blind placebo-controlled study

Leen, Clifford; Dunbar, E M; Ellis, Mark; Mandal, B K

doi:10.1016/0163-4453(90)90646-p

Cited by 64 publications

(20 citation statements)

References 5 publications

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“…The e cacy and safety of uconazole in the treatment of oral thrush associated with HIV infection has been demonstrated [1,2], but the frequency of relapses is high and increases with the patient immunode®ciency. The management of oropharyngeal candidiasis in HIV+ patients using a secondary prevention with¯uconazole (50±150 mg once a week) has thus been proposed, and the e cacy and safety of this approach are now established [3,4,5]. This strategy presents advantages with respect to cost, compliance and drug interactions [6].…”

Section: Introductionmentioning

confidence: 99%

Population pharmacokinetics of fluconazole given for secondary prevention of oropharyngeal candidiasis in HIV-positive patients

Csajka

Décosterd

Buclin

et al. 2001

Eur J Clin Pharmacol

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Objectives: To determine¯uconazole population pharmacokinetics and explore the relationships between¯uconazole average concentration and treatment e ectiveness or microbiological resistance induction during a study aimed at evaluating the e cacy, tolerability and resistance induction after secondary prevention with¯uconazole (150 mg weekly) versus placebo in human immunode®ciency virus-positive (HIV+) patients with oropharyngeal candidiasis. Methods: Population pharmacokinetic parameters of uconazole determined from 458 serum drug concentration measurements obtained over 37 months in 132 HIV+ patients not receiving highly active antiretroviral therapy. Mean estimates and variabilities were generated using non-linear regression analysis. Logistic and linear regression analyses were used to explore the relationships between the estimated average concentration of uconazole and candidiasis relapse or fungal resistance towards¯uconazole. Results: Fluconazole kinetics were best described by a one-compartment model with ®rst-order oral absorp tion from the gastrointestinal tract. The pharmacokinetics were in¯uenced only by body weight. No e ect was observed for gender, age, height or lymphocyte CD4 counts. The mean apparent population clearance was 0.79 l/h, the volume of distribution 57 l and the absorption constant (k a ) 0.93 h ±1 . Inter-occasion variability in clearance (45%) was large relative to intersubject variability (21%). Taking into account the average¯uconazole concentration or the time above the minimal inhibitory concentrations did not clinically improve the prediction of the occurrence of oropharyngeal relapse or microbiological resistance. Conclusion: The relationship between¯uconazole concentrations and preventive e ectiveness was poor. Together with the rather large inter-occasion variability in¯uconazole clearance, this suggests no role of therapeutic drug monitoring in optimising¯uconazole treatment for secondary prevention.

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Section: Introductionmentioning

confidence: 99%

Population pharmacokinetics of fluconazole given for secondary prevention of oropharyngeal candidiasis in HIV-positive patients

Csajka

Décosterd

Buclin

et al. 2001

Eur J Clin Pharmacol

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“…For example, azole resistance in C. albicans results from point mutations, the overexpression of the ERG11 gene, and the overexpression of the efflux pumps encoded by CDR1, CDR2, and MDR1 (12). FLC resistance in strains in HIV-infected patients was common in the 1980s and 1990s due to the use of FLC prophylaxis for the prevention of oropharyngeal candidiasis (5,8,11). Müller et al reported cross-resistance to FLC, ITC, and VRC among oropharyngeal candidiasis isolates from HIV-infected patients (6).…”

mentioning

confidence: 99%

Cross-Resistance to Medical and Agricultural Azole Drugs in Yeasts from the Oropharynx of Human Immunodeficiency Virus Patients and from Environmental Bavarian Vine Grapes

Müller

Staudigel

Salvenmoser

et al. 2007

Antimicrob Agents Chemother

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Cross-resistance among Candida albicans isolates from the oropharynges of human immunodeficiency virus-infected patients (n = 16) and environmental yeast strains of various species (n = 54) to medical and agricultural azole drugs was observed. Precautions against the unnecessary widespread use of azoles in the environment and human medicine are strongly recommended to prevent patients from acquiring azole-resistant yeasts.

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“…Eine Sekundärprophylaxe bei Patienten mit rekurrierenden Kandidosen des oberen GITraktes sollte jedoch dennoch erfolgen. Sehr gut bewährt hat sich hierbei die tägliche Gabe von Fluconazol in einer Dosierung von 50 -100 mg oder die Gabe von 150 mg einmal wç-chentlich [31,32]. Die Behandlung der CMV-Erkrankung ist auf die intravençse Therapie mit Ganciclovir, Foscarnet, Cidofovir und Valganciclovir beschränkt [33].…”

Section: Die Klinikunclassified

Diagnostik und Therapie der HIV-assoziierten Ösophagitis

Neumann

Mönkemüller²

2007

Z Gastroenterol

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Diseases of the gastrointestinal tract are one of the most common complication of the acquired immunodeficiency syndrome (AIDS). Although there have been advances in the diagnosis and therapy of GI diseases in AIDS, currently, the diagnosis of and therapy for such opportunistic diseases still represent a challenge. The following article focuses on the diagnostic approach, differential diagnosis of and therapy for opportunistic esophageal diseases in AIDS.

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Once-weekly fluconazole to prevent recurrence of oropharyngeal candidiasis in patients with AIDS and AIDS-related complex: A double-blind placebo-controlled study

Cited by 64 publications

References 5 publications

Population pharmacokinetics of fluconazole given for secondary prevention of oropharyngeal candidiasis in HIV-positive patients

Population pharmacokinetics of fluconazole given for secondary prevention of oropharyngeal candidiasis in HIV-positive patients

Cross-Resistance to Medical and Agricultural Azole Drugs in Yeasts from the Oropharynx of Human Immunodeficiency Virus Patients and from Environmental Bavarian Vine Grapes

Diagnostik und Therapie der HIV-assoziierten Ösophagitis

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