{"id":275,"date":"2008-12-26T08:41:02","date_gmt":"2008-12-26T07:41:02","guid":{"rendered":"http:\/\/localhost\/new\/htb\/?p=275"},"modified":"2013-08-23T13:08:35","modified_gmt":"2013-08-23T13:08:35","slug":"single-high-dose-fluconazole-for-oropharyngeal-candidiasis","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/275","title":{"rendered":"Single high dose fluconazole for oropharyngeal candidiasis"},"content":{"rendered":"

Simon Collins, HIV i-Base<\/strong><\/p>\n

Results of a randomised, double-blind, placebo controlled trial in Tanzania of single high-dose oral fluconazle was reported by Omar Hamza and colleagues from Muhimbili University, Tanzania.<\/strong><\/p>\n

The trial randomised 220 HIV-positive patients with clinical and mycological evidence of oropharyngeal candidiasis to receive oral fluconazole doses of either 750-mg single dose or standard dose of 150 mg once-daily for 2 weeks. Each arm included 110 patients.<\/p>\n

Results were similar in each group and are detailed in Table 1. There were no statistically significant differences between the two groups. Approximately 95% patients were clinically cured (OR, 0.825; 95% CI, 0.244-2.789; p=0.99) and 85-75% mycologically cured (OR, 1.780; 95% CI, 0.906-3.496; p=0.129).<\/p>\n

Table 1: Results from single dose vs 2-week fluconazole<\/strong><\/p>\n\n\n\n\n\n\n\n\n
<\/th>\n750mg single dose<\/th>\n14-day 150mg dose<\/th>\n<\/tr>\n
Clinical cure<\/td>\n104 pts (94.5%)<\/td>\n105 pts (95.5%)<\/td>\n<\/tr>\n
Clinical improvement<\/td>\n2 pts (1.8%)<\/td>\n4 pts (3.6%)<\/td>\n<\/tr>\n
Treatment failure<\/td>\n4 pts (3.6%)<\/td>\n1 (0.9%)<\/td>\n<\/tr>\n
Mycological cure<\/td>\n93 pts (84.5%)<\/td>\n83 pts (75.5%)<\/td>\n<\/tr>\n
Mycological failure<\/td>\n17 pts (15.5%)<\/td>\n27 pts (24.5%)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Overall, clinical cure was not achieved in 11 patients and for all of them, Candida species were isolated from patient specimens at baseline and on day 14. In 33 patients (15.0%), clinical cure was obtained despite persistent positive culture results on day 14 (mycological failure).<\/p>\n

No differences were observed in relapse rates (OR, 1.073; 95% CI, 0.456-2.523; P=0.99). The average time to relapse after clinical cure was 18-20 days. Twenty-two (91.7%) of 24 patients who experienced relapse during follow-up had CD4 cell counts <200 cells\/mm3, 16 (66.7%) had CD4 cell counts <100 cells\/mm3, 17 (70.8%) were not receiving HAART, and 14 (58.3%) had had previous episodes of OPC.<\/p>\n

The mean plasma fluconazole concentrations on days 1, 4 or 5, 7, and 14 in the 14-day fluconazole group were 13.35, 5.46, 1.37, and 0.32 mg\/L and 4.18, 6.88, 7.94, and 7.62 mg\/L, for the single-dose and 14-day groups respectively. These differences were statistically significant for days 1, 7 and 14.<\/p>\n

Overall, adverse events were mild, and no differences in frequency of adverse events were noted between patients in the 2 treatment regimens. Because most of the study patients were in an advanced stage of HIV infection and AIDS, abnormalities in full blood count and liver function tests were common.<\/p>\n

In this study, the mycological cure rate, with a single-dose treatment of 750 mg fluconazole, was much higher (84.5%) than the 6%-41% mycological cure rates reported from studies using 150mg single dose treatment.<\/p>\n

The authors concluded “The use of a single high dose of fluconazole … presents the advantages of simplicity and convenience, thus improving compliance and reducing the cost of therapy. A single dose of five 150-mg tablets is less costly than fourteen 150-mg tablets taken over a 14-day course and, therefore, could be used, especially in resource-limited settings like in sub-Saharan Africa. In addition, administration of the single-dose therapy can be observed directly by medical personnel, thereby assuring patient compliance.”<\/p>\n

Reference:<\/p>\n

Omar J et al. Single-Dose Fluconazole versus Standard 2-Week Therapy for Oropharyngeal Candidiasis in HIV-Infected Patients: A Randomized, Double-Blind, Double-Dummy Trial. Clinical Infectious Diseases 15 November 2008, Vol. 47, No. 10: 1270-1276.<\/p>\n","protected":false},"excerpt":{"rendered":"

Simon Collins, HIV i-Base Results of a randomised, double-blind, placebo controlled trial in Tanzania of single high-dose oral fluconazle was reported by Omar Hamza and colleagues from Muhimbili University, Tanzania. The trial randomised 220 HIV-positive patients with clinical and mycological …<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[31],"tags":[],"class_list":["post-275","post","type-post","status-publish","format-standard","hentry","category-opportunistic-infections-coinfections-and-complications"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/275","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=275"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/275\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=275"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=275"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=275"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}