CORRELATION BETWEEN ANTIFUNGAL SUSCEPTIBILITY TESTING OF CANDIDA ISOLATES FROM PATIENTS WITH HIV-INFECTION AND CLINICAL-RESULTS AFTER TREATMENT WITH FLUCONAZOLE

In an open-label controlled study 23 HIV-infected patients (CDC IV A-E ) with documented oropharyngeal candidosis were treated with 100 mg fl uconazole orally over 5 days (53 episodes; 16 treatments/patient). Eff icacy data were compared with a control group of 21 patients who recei ved treatment for 10-21 days with 100 mg fluconazole for candidosis. C andida isolates were repeatedly recovered from patients before and aft er treatment with fluconazole and antifungal susceptibility testing (m icrobroth-dilution) was done. Inoculum size, medium pH, incubation tim e and temperature were standardized. Up to 85% of patients responded t o therapy clinically and mycologically. Candida albicans was the most important yeast (86%) isolated from cultures of oral washings.; In 90% of C. albicans isolates MIC to fluconazole were low (less than or equ al to 1.56 mg/l). Primary resistance to fluconazole was not seen, but secondary resistance occurred in two cases clinically and in vitro (MI C greater than or equal to 25 mg/l). Short treatment for 5 days was as successful as for 10 to 21 days without leading to significantly more recurrences of oral candidosis in these patients. Selection of Candid a spp. other than C. albicans (e. g. Candida krusei, Torulopsis glabra ta) under repeated fluconazole treatment occurred rarely. One patient developed clinical signs of chronic recurrent candidiasis, where only C. krusei could be cultured repeatedly.