FLUCONAZOLE CONCENTRATIONS IN SALIVA FROM AIDS PATIENTS WITH OROPHARYNGEAL CANDIDOSIS REFRACTORY TO TREATMENT WITH FLUCONAZOLE

Fluconazole (FCZ) has been extensively used as a primary therapy for o ropharyngeal candidosis in AIDS patients. Clinical resistance to FCZ i s now encountered, often related to decreased susceptibility of the is olate in vitro, We wondered if low levels in saliva play a role in the therapeutic failure, especially in patients complaining of dry mouth, Sixteen AIDS patients treated for oropharyngeal candidosis with FCZ w ere studied, MICs for the isolates were determined, Serum and saliva s amples were collected to measure FCZ levels with a bioassay using pape r disks loaded with the clinical specimens, We showed that (i) paper d isks were convenient for collecting saliva in patients with dry mouth; (ii) levels in saliva depended on the FCZ dosage regimen but did not correlate with the response to therapy; (iii) correlation between conc entrations in saliva and serum was poor and independent of clinical re sponse to treatment, other therapies, or decreased salivation; and (iv ) levels in saliva were always lower than MICs in patients who failed to respond to treatment, In conclusion, therapeutic failures are more likely to be related to in vitro resistance of the isolate to FCZ or i nsufficient dosage regimen than to decreased salivary secretion.