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[Effect of orally administered polyene antimycotics on the intestinal colonization with yeasts: possibilities and
R Blaschke-Hellmessen1, H Buchmann, R Schwarze
1Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, FR Germany.
Abstract:
On the basis of intestinal yeast colonization different consequences for therapeutic and prophylactic administration of polyene antimycotics have to be drawn. Immunocompromised neutropenic patients should orally receive polyene antifungal drugs (nystatin or amphotericin B) for a long time during the period of increased risk for systemic candidosis. The level of daily dosing is dependent on age, physiological status of the gastrointestinal tract, and underlying disease of the patient. In immunocompetent persons the normal commensal yeast flora should not be suppressed by antifungal chemoprophylaxis if no clinical indications are present, because permanent eradication of yeast in the intestinal tract ist not attainable. About 5 to 15 days after finishing the administration of polyene antimycotics the fungi are detectable again in the faeces in low quantities. The influence of orally administered polyene drugs in the intestinal tract may be detected shortly after starting the application. Thus efficient concentrations of nystatin and amphotericin B are continuously present in the faeces 24 to 48 hours after beginning until 2 to 10 days after finishing the administration. During this time the quantity of yeast in the faeces is evidently reduced or not longer detectable by fungal culture. The oral administration of polyene antimycotics for a long time in persons without immunodepression and without heavy intestinal yeast colonization is not justified.
Insights
Polyene antimycotics like nystatin are crucial for immunocompromised patients at risk of systemic candidosis. However, antifungal chemoprophylaxis is not recommended for immunocompetent individuals due to yeast
Area of Science:
- Medical Mycology
- Pharmacology
Context:
- Intestinal yeast colonization impacts antifungal treatment strategies.
- Polyene antimycotics (nystatin, amphotericin B) are used for candidosis.
- Risk stratification is essential for appropriate antifungal use.
Purpose:
- To delineate the consequences of intestinal yeast colonization for polyene antimycotic therapy.
- To establish guidelines for the therapeutic and prophylactic administration of polyene antifungals.
Summary:
- Immunocompromised neutropenic patients require long-term oral polyene antifungals during high-risk periods for systemic candidosis.
- Dosage must be individualized based on patient factors like age, GI status, and disease.
- Antifungal chemoprophylaxis is not advised for immunocompetent individuals without clinical indications, as intestinal yeast eradication is not permanent.
- Polyene drugs achieve effective fecal concentrations within 24-48 hours of administration and persist for days after cessation, reducing yeast counts.
Impact:
- Informs clinical decisions regarding the duration and necessity of polyene antimycotic use.
- Highlights the importance of tailoring antifungal therapy to patient immune status.
- Discourages unnecessary antifungal chemoprophylaxis in immunocompetent populations, preserving normal gut flora.