CHANGE OF CANDIDAL SUSCEPTIBILITIES TO FL UCONAZOLE AFTER ARREST OF THE SYSTEMATIC PROPHYLAXIS OF OROPHARYNGEAL PROPHYLAXIS

The efficacy and safety of fluconazole were such that this drug was pr oposed as secondary prophylaxis of oropharyngeal candidiasis in HIV in fected patients. With this exposure, resistance emerged, The results o f the susceptibilities of Candida isolated from 154 and 146 patients i ncluded into two separated cross-sectional studies (the first with sys tematic prophylaxis with fluconazole and the second without) were repo rted. The proportion of C. albicans vs ''non-albicans'' was different : 88/17 vs 98/8 during the first and second period respectively, (p = 0,02). Both the percentage of resistant (5,6 % vs 6,7 %, p = 0,71) and the distribution of the levels of susceptibility of C. albicans did n ot change significantly. By using a multivariate analysis, the resista nce of C. albicans was significantly linked to the cumulate dose of fl uconazole (R(2) = 0,23, p = 0,0054). Otherwise, the delay without fluc onazole was shorter for patients with resistant strains than for patie nts with susceptible Candida (1,7 month vs 3,7 month, Log rank test, p = 0,01), indicating the persistance of own strains, These results ind icate the need for new drugs which do not share the mecanisms of azole resistance and new therapeutic strategies.