Itraconazole oral solution for treatment of fluconazole resistant oral/esophageal candidosis in HIV-infected patients II - Mycological study

Aim. To evaluate the susceptibility to fluconazole and itraconazole of stra ins of Candida isolated from HIV-positive patients with oral and/or esophag eal candidosis clinically fluconazole-resistant. We also aimed to investiga te whether the susceptibility or resistance in vitro of the strains isolate d was correlated with the clinical outcome of patient treated with itracona zole from whom the strains were isolated. Patients. Mycological follow-up of 25 patients included in the itraconazole FRA-005 study (20). Framework: 8 university and hospital laboratories. Pat ients: 25 AIDS patients with oral and/or esophageal candidosis treated for at least 14 days with fluconazole at a minimum dose of 100 mg/day for the o ral candidosis and 200 mg/day for esophageal candidosis. The patients were treated orally with a solution of itraconazole in hydroxy-propyl-lj-cyclode xtrin at a dose of 100 mg/day for 14 days, and 200 mg/day for the next 14 d ays if required. Methods. Identification, counting and determination of susceptibility to fl uconazole and itraconazole (MIC) by Etest of Candida strains isolated after positive direct examination of the samples taken at inclusion of the patie nts (D0 = day 0). Mycological follow-up of the patients at D14, and in some cases at D28. Results. 28 strains of Candida were isolated on DO from the 25 AIDS patient s studied. Twenty five of these strains were C. albicans, 2 were C. krusei and 1 was C. glabrata. On RPMI medium, 16 strains were found to be resistan t to fluconazole and only 5 were resistant to itraconazole. Clinical cure w as achieved for 15 patients on D14 and for 2 patients on D28. The remaining 8 patients showed an improvement both in signs and symptoms on D28. Eighty percent of patients carrying strains susceptible to itraconazole were clin ically cured or improved. The obtention of negative results for all mycolog ical cultures was rare.