Prolonged Oral Treatment of Chronic Mucocutaneous Candidiasis With Amphotericin B

Montes, Leopoldo F.

doi:10.1001/archderm.1971.04000190047007

Cited by 16 publications

(6 citation statements)

References 30 publications

(1 reference statement)

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“…Unfortunately the drugs used often exhibit severe side effects e.g. amphotericin B produces renal damage, nausea, vomiting and fever [23], miconazole causes liver damage, phlebitis and nausea [10], clotrimazole leads to liver, neurological and gastrointestinal reactions [17] and fluocytosin causes neutropenia and hepatitis [2]. A low toxicity-drug is particularly desirable for treatment of candida nail infections, as this usually requires several months of therapy.…”

Section: Discussionmentioning

confidence: 99%

Intermittent ketoconazole therapy of chronic mucocutaneous candidiasis in childhood

et al. 1982

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We report the clinical and laboratory findings in two children with chronic mucocutaneous candidiasis (CMC) treated successfully with intermittent long-term ketoconazole therapy. Both had chronic infection of the nails, skin and mucous membranes with positive cultures for candida. Both were resistant to multiple local and systemic antifungal agents. After institution of ketoconazole therapy there was a dramatic improvement with clearing of the oral (one week), skin (two months) and nail lesions (5 months). After 8 months the drug was stopped and clinical remission persisted for 10 and 7 months respectively. Relapse of oral candidiasis was treated with a short course of ketoconazole (4-16 weeks) leading to complete healing of the lesions. Clinical improvement was not related to an amelioration in lymphocyte transformation. There was no change in the progressive deterioration of the lymphocyte responses to candida antigen which was probably due to persisting candida cell wall components (e.g. mannan).

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Section: Discussionmentioning

confidence: 99%

Intermittent ketoconazole therapy of chronic mucocutaneous candidiasis in childhood

et al. 1982

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“…Various formulations of amphotericin B for oral administration have been described, including tablets [207,208,[210][211][212], lozenges [6,213], gargles [214], syrups [215], suspensions [216][217][218][219][220] and solutions [221][222][223][224]. Indications for such formulations included cutaneous and pulmonary manifestations of blastomycosis [207,208], mucocutaneous candidiasis [210,211], treatment [6,211,217,[221][222][223][224][225][226][227] and prophylaxis [ oropharyngeal candidiasis and denture stomatitis [213]. Recently, many of the reports of the therapeutic use of orally administered amphotericin B suspension focus on its use in oropharyngeal candidiasis refractory to azole therapy [216,218].…”

Section: Amphotericin Bmentioning

confidence: 99%

Novel modes of antifungal drug administration

Arthur¹,

Drew²,

Perfect³

2004

Expert Opinion on Investigational Drugs

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Administration of antifungals by routes other than that for which the agent was designed or approved have been utilised in attempts to provide directed therapy, reduce adverse effects and improve drug penetration into selected infection sites, such as the central nervous system, lungs and peritoneum. The most widely investigated agent utilising a novel method of drug delivery is amphotericin B. Dose forms for this agent include topicals (aerosol, nasal spray, irrigations, pastes, absorbable sponges, impregnated bone cement and gelatin), oral dosage forms (solutions, suspensions, tablets and so on) and ophthalmic preparations (drops, ointments and injections). Amphotericin B has been administered by routes such as oral, endobronchial, intrathecal, intracisternal, intra-articular, intraperitoneal, ophthalmic and as an antibiotic 'line lock'. Nystatin has been administered as an aerosol, percutaneous paste and bladder washes. Azoles, such as miconazole, fluconazole, ketoconazole and posaconazole, have been administered by novel methods but to a lesser degree. Most of these reports involve miconazole. The dose forms and routes of administration for azoles have included irrigants (bladder, joint), ophthalmic preparations (eye drops, intraocular injections, ointments), impregnated bone cement, endobronchial and intrathecal administration. Finally, both methylene blue (bladder washes) and flucytosine (peritoneal lavage, ophthalmic eye drops) have also been employed. Adequate evaluations of both the safety and efficacy of these therapies are most often hindered by prior or concomitant antifungal therapies, comorbidities and the lack of controlled clinical trials. In addition, the availability of newer treatment options, which demonstrate significant improvement in drug distribution and treatment-related adverse effects make many such novel modes of administration less practical or necessary. In contrast, the inhalation of antifungal aerosols, such as amphotericin B, is rapidly becoming a viable prophylactic option.

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“…Its use in immunocompromised patients has been studied for broad-spectrum fungal prophylaxis [23] and it has less commonly been used for treatment of oropharyngeal candidosis in other immunodeficiencies, with variable results depending on the preparation [2,3,8,11,17,24,25].…”

Section: Casementioning

confidence: 99%

“…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.…”

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confidence: 99%

Efficacy of oral amphotericin B in AIDS patients with thrush clinically resistant to fluconazole

Dewsnup¹,

Stevens²

1994

Med Mycol

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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

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Prolonged Oral Treatment of Chronic Mucocutaneous Candidiasis With Amphotericin B

Cited by 16 publications

References 30 publications

Intermittent ketoconazole therapy of chronic mucocutaneous candidiasis in childhood

Intermittent ketoconazole therapy of chronic mucocutaneous candidiasis in childhood

Novel modes of antifungal drug administration

Efficacy of oral amphotericin B in AIDS patients with thrush clinically resistant to fluconazole

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