THERAPY FOR OROPHARYNGEAL CANDIDIASIS IN HIV-INFECTED PATIENTS - A RANDOMIZED, PROSPECTIVE MULTICENTER STUDY OF ORAL FLUCONAZOLE VERSUS CLOTRIMAZOLE TROCHES

A total of 334 HIV-infected patients with oral candidiasis were random ly assigned to receive 14 days of treatment with either 100 mg of oral fluconazole once daily or 10 mg clotrimazole five times daily. Both t reatments were clinically effective: 98% of evaluable fluconazole-trea ted patients and 94% of evaluable clotrimazole-treated patients were c ured or showed improvement (p = NS). Fluconazole was more effective th an clotrimazole in eradicating Candida from the oral flora by the end of therapy (65% versus 48%) (p = 0.005). In addition, patients in the fluconazole-treated group were more likely to remain asymptomatic thro ugh the second week of follow-up (82.3% versus 50.0%) (p < 0.001). Thi s difference was no longer evident by the post-therapy visit during we ek 4. Seven patients treated with clotrimazole and two patients treate d with fluconazole discontinued therapy because of side effects. Two p atients in the fluconazole group were withdrawn from therapy because o f elevated serum glutamic-oxaloacetic transaminase levels, one conside red possibly related to drug therapy. Fluconazole was as effective as clotrimazole in the treatment of oral candidiasis and temporarily prov ided a more prolonged disease-free state. Future studies are needed to define the optimal regimen for both the treatment and prevention of r ecurrent oral candidiasis in HIV-infected patients, addressing special attention to the issue of compliance, cost, and emergence of resistan ce.