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Diflucan dosage for esophageal thrush,male thrush no symptoms,candida parapsilosis and fluconazole - PDF Books

Author: admin, 22.03.2015

In 2008, the Subcommittee for Antifungal Testing of the Clinical Laboratory Standards Institute (CLSI) defined breakpoints for antifungal agents active against Candida species. The Guidelines for Prevention and Treatment of Opportunistic Infections in Adults and Adolescents provides recommended preferred and alternative treatment options for fluconazole-refractory oropharyngeal and esophageal candidiasis (Figure 5. Available treatment options for fluconazole-refractory oropharyngeal candidiasis include topical therapy, oral systemic agents, and intravenous therapy. The emergence of fluconazole-resistant candidiasis in HIV-infected persons correlated with the widespread use of fluconazole for oropharyngeal candidiasis during this time period.
Treatment of Fluconazole-Refractory Oropharyngeal and Esophageal Candidiasis">Figure 5)[3]. Amphotericin B oral suspension is the best-studied topical therapy for fluconazole-resistant candidiasis.
Patients with cryptococcal meningitis or recurrent esophageal candidiasis require continuous fluconazole therapy, but systemic antifungal therapy can usually be avoided in patients with less advanced HIV disease and for less serious fungal infections.

These guidelines give the highest rating for itraconazole (Sporanox) oral solution and posaconazole (Noxafil) oral solution. The opportunistic infections guidelines do not provide a specific duration of therapy, but most experts would recommend at least 10 days of therapy for patients with fluconazole-refractory oropharyngeal candidiasis, with extension of the treatment course if the response is not complete at day 10. Patients with esophageal candidiasis should generally receive a minimum of 21 days of therapy.
One study involving 176 HIV-infected patients with fluconazole-refractory oropharyngeal or esophageal candidiasis reported good response rates with oral posaconazole[27]. Factors that can affect clinical response include the immune status of the patient, adherence to antifungal therapy, and the potential presence of biofilms formed by Candida organisms[6]. In addition, voriconazole is also available in an oral form and it has excellent bioavailability. Investigators found voriconazole (200 mg PO bid) to be at least as effective as fluconazole in the treatment of esophageal candidiasis, but this study did not involve fluconazole-refractory candidiasis[22].

The selective action of fluconazole for fungal cell membranes occurs because human cells use cholesterol, not ergosterol, for the synthesis of cell membranes. In vitro studies with caspofungin have shown excellent activity against fluconazole-resistant isolates[23] and clinical studies have shown good responses with caspofungin in patients with esophageal candidiasis[24], including fluconazole-refractory cases[25].
From a clinical standpoint, treatment-refractory candidiasis is defined as signs and symptoms of candidiasis that persist for longer than 7 to 14 days after appropriate therapy[3].

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