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Objective: To examince the impact ot continuous versus intermittent Fluconazole therapy on fungal colonization and fluconazole resistance in the oophaynx of HIV-infected patients.

Design: Case-conrol study.

Seting: Duke University Adult Infectious Diseases clinic, A teriary referral center in North Carolina which provies care for 700 HIV-infected persons

Patients: Nineteen HIV-infected patients on daily continusous fluconazole for a minimum of 6 months and eleven HIV-infected patients on intermitent luconazole for a minimum of 6 months were matched by sex and CD4 Cell count to HIV-infected patients who had not received fluconazole in the preceding 6 months.

Main oucome measures: Fungal isolation an fluconazole susceptibility testing were performed on oral saline rinses from each patient

Results: The patients taking coninuous fluconazole were more likely than matched conrols to have had sterile mouth rinses (14 out of 19 versus five out of 19; P <0.001), and the yeasts that were isolated were more likely than matched conrols o be non-cCandida albicans species and to have minimum inhibitory concentrations (MIC) to fluconazole <=16g/ml. None of these isolates were associated with sympoms. In conrast, none of the patients in the intermitent fluconazole group had sterile cultures. When this roup was compared o conrols, they were more likely to have had non-C. Albicans species, and C. Albicans isolates obtained had higher MIC o fluconazole.

Conclusions: Long-term continuous therapy wih fluconazole may prevent the appearance of Candida in the oral civity. This finding may reduce recurrence rates and miht favorably impact on the clinical appearance of mucosal candidiasis wih resistant C. albicans.

(C) Lippincott-Raven Publishers.