VARIATION IN FLUCONAZOLE EFFICACY FOR CANDIDA-ALBICANS STRAINS SEQUENTIALLY ISOLATED FROM ORAL CAVITIES OF PATIENTS WITH AIDS IN AN EXPERIMENTAL MURINE CANDIDIASIS MODEL
F. Barchiesi et al., VARIATION IN FLUCONAZOLE EFFICACY FOR CANDIDA-ALBICANS STRAINS SEQUENTIALLY ISOLATED FROM ORAL CAVITIES OF PATIENTS WITH AIDS IN AN EXPERIMENTAL MURINE CANDIDIASIS MODEL, Antimicrobial agents and chemotherapy, 40(5), 1996, pp. 1317-1320
Four strains of Candida albicans, isolated from two patients with AIDS
who had undergone prolonged fluconazole therapy for oral candidiasis,
were studied in a model of disseminated murine candidiasis. Pre- and
posttreatment isolates from each patient were genetically related, and
the fluconazole MICs for the strains had increased significantly, fro
m 0.25 to 32 mu g/ml for the strains isolated from patient 1 and from
1.0 to 16 mu g/ml for the strains isolated from patient 2. Mice were i
nfected intravenously and were treated orally with fluconazole. For su
rvival studies, mice were treated from day 1 to day 10 postinfection a
nd were observed through day 30. The fluconazole dosages were as follo
ws: 0.25, 0.5, 1.0, and 5.0 mg/kg of body weight twice a day. For tiss
ue burden studies, two groups of mice (each group received fluconazole
at 0.25 or 5.0 mg/kg) were treated from day 1 to day 7 and were sacri
ficed 1 day later for quantitative tissue cultures of the spleen and b
oth kidneys. For pretreatment isolates from both patients, all flucona
zole dosing regimens were effective at prolonging survival compared wi
th the survival of the control groups. For posttreatment isolates, onl
y fluconazole at 5.0 mg/kg was effective at prolonging survival. Both
fluconazole dosing regimens used in the tissue burden studies signific
antly reduced the counts of the pretreatment isolate from patient 1 in
the spleen and kidney, while fluconazole at 5.0 mg/kg was effective a
t reducing the counts of the posttreatment isolate, For both isolates
from patient 2, only fluconazole at 5.0 mg/kg was effective at reducin
g the counts in the spleen and kidney. The study indicates that C. alb
icans mutation to resistance to fluconazole may play a critical role i
n fluconazole-refractory oral candidiasis in AIDS patients.