Fluconazole treatment of fungal infections in the immunocompromised host

Area of Science:

• Mycology
• Infectious Diseases
• Clinical Pharmacology

Background:

• Immunocompromised patients are susceptible to opportunistic fungal infections, primarily candidiasis.
• Current antifungal options like amphotericin B, 5-fluorocytosine, and ketoconazole have limitations in efficacy, administration, or resistance.
• There is a need for effective and well-tolerated antifungal agents for managing candidiasis, especially systemic infections.

Purpose of the Study:

• To evaluate the efficacy and safety of fluconazole, a new triazole antifungal, in treating candidiasis in immunocompromised patients.
• To compare fluconazole with ketoconazole for oropharyngeal candidiasis.
• To assess preliminary outcomes of intravenous fluconazole for systemic candidiasis and fungemia.

Main Methods:

• A randomized, double-blind study compared oral fluconazole (100 mg/d) with ketoconazole (400 mg/d) in cancer patients with oropharyngeal candidiasis.
• Intravenous fluconazole (100-300 mg/d) was administered to a small cohort of patients with systemic candidiasis, including fungemia.
• Clinical and microbiological outcomes, as well as relapse rates, were monitored.

Main Results:

• Clinical and microbiological outcomes were comparable between oral fluconazole and ketoconazole for oropharyngeal candidiasis.
• Patients treated with fluconazole experienced relapses later compared to those treated with ketoconazole.
• Preliminary results for intravenous fluconazole in systemic candidiasis and fungemia are encouraging.

Conclusions:

• Fluconazole appears to be an effective agent for oropharyngeal candidiasis with a potentially lower relapse rate than ketoconazole.
• Intravenous fluconazole shows promise for treating systemic candidiasis and fungemia in immunocompromised patients.
• Further research is warranted to establish specific indications for fluconazole in immunocompromised populations, including its use as prophylaxis.