EMERGENCE OF FLUCONAZOLE-RESISTANT STRAINS OF CANDIDA-ALBICANS IN PATIENTS WITH RECURRENT OROPHARYNGEAL CANDIDOSIS AND HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

After repeated use of fluconazole for therapy of oropharyngeal candido sis, the emergence of in vitro fluconazole-resistant Candida albicans isolates (MIC, greater than or equal to 25 mu g/ml) together with oral candidosis unresponsive to oral dosages of up to 400 mg of fluconazol e were observed in patients,vith human immunodeficiency virus (HIV) in fection. Antifungal susceptibility testing was done by broth microdilu tion and agar dilution techniques on C. albicans isolates recovered fr om a cohort of patients with symptomatic HIV infection who were treate d repeatedly with fluconazole for oropharyngeal candidosis. In vitro f indings did show a gradual increase in the MICs for C. albicans isolat es recovered from selected patients with repeated episodes of orophary ngeal candidosis. Primary resistance of C. albicans to fluconazole was not seen. Cross-resistance in vitro occurred between fluconazole and other azoles (ketoconazole, itraconazole), but to a lesser extent. The results of the study suggest that the development of clinical resista nce to fluconazole could be clearly correlated to in vitro resistance to fluconazole. Itraconazole may still serve as an effective antifunga l agent in patients with HIV infection and oropharyngeal candidosis no nresponsive to fluconazole.