INFLUENCE OF ORALLY-ADMINISTERED POLYENE ANTIMYCOTICS ON THE INTESTINAL COLONIZATION WITH YEASTS - POSSIBILITIES AND LIMITATIONS

On the basis of intestinal yeast colonization different consequences f or therapeutic and prophylactic administration of polyene antimycotics have to be drawn. Immunocompromised neutropenic patients should orall y receive polyene antifungal drugs (nystatin or amphotericin B) for a long time during the period of increased risk for systemic candidosis. The level of daily dosing is dependent on age, physiological status o f the gastrointestinal tract, and underlying disease of the patient. I n immunocompetent persons the normal commensal yeast flora should not be suppressed by antifungal chemoprophylaxis if no clinical indication s are present, because permanent eradication of yeast in the intestina l tract ist not attainable. About 5 to 15 days after finishing the adm inistration of polyene antimycotics the fungi are detectable again in the faeces in low quantities. The influence of orally administered pol yene drugs in the intestinal tract may be detected shortly after start ing the application. Thus efficient concentrations of nystatin and amp hotericin B are continuously present in the faeces 24 to 48 hours afte r beginning until 2 to 10 days after finishing the administration. Dur ing this time the quantity of yeast in the faeces is evidently reduced or not longer detectable by fungal culture. The oral administration o f polyene antimycotics for a long time in persons without immunodepres sion and without heavy intestinal yeast colonization is not justified.