Flucytosine
Mahmoud A. Ghannoum, John R. Perfect in Antifungal Therapy, 2019
Mucocutaneous forms of candidiasis have been successfully treated with flucytosine, administered either systemically or locally. Topical creams have been successfully used in the treatment of vulvovaginal candidiasis [1,46,156–162]. Treatment of esophageal candidiasis has also been investigated. Flucytosine 100 mg/kg/daily was compared with fluconazole and placebo in the treatment of the first episode of esophageal candidiasis in 60 patients with AIDS in a double-blind crossover study [163]. Endoscopic cure was reported in 9 (70%) and 9 patients (33%) in the fluconazole and flucytosine groups, respectively. Currently, use of flucytosine for mucocutaneous disease is restricted primarily to the topical treatment of recalcitrant vulvovaginal candidiasis due to the availability of alternate therapies [1].
HIV and AIDS Pain
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
Chest pain, dysphasia, and odynophagia are all manifestations of esophageal disease in HIV. Esophageal candidiasis is the most common cause of these symptoms. Although common, oral candida may be absent in these patients. Esophageal candidiasis is an AIDS-defining opportunistic infection and is indicative of late-stage disease (CD4 < 200). Patients usually present with dysphasia and/or odynophagia, usually localizing their pain to the substernal area. These symptoms should prompt empiric treatment with a systemic antifungal agent. If there is no response to therapy in 3 to 4 days, endoscopy with biopsy should be done (Darouich, 1998). Other than candidal infections, the most common findings are esophageal ulcers, which may be due to HSV, CMV, or idiopathic aphthous disease. The diagnosis is made by biopsy. Idiopathic ulcers usually respond to systemic steroids. Resolution of pain occurs with treatment of the causative agent. With esophageal ulcers, analgesics may be necessary as pain may respond slowly to specific therapy.
Voriconazole
M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson in Kucers’ The Use of Antibiotics, 2017
Voriconazole also has approval for the treatment of esophageal candidiasis. In a randomized, double-blind, multicenter trial, the efficacy and safety of voriconazole (200 mg p.o. twice a day) was compared with that of fluconazole (400 mg p.o. on day 1, then 200 mg daily) for the treatment of esophageal candidiasis in 391 immunocompromised patients (Ally et al., 2001). Based on an endoscopy endpoint, voriconazole was found to be at least as effective (98% success rate) as fluconazole (95% success rate). Although generally mild, treatment-related adverse events were more common in patients receiving voriconazole (30%) than in those receiving fluconazole (14%). Considering the safety, relative effectiveness, and cost, fluconazole remains the drug of choice for many Candida infections. The clinical use of voriconazole has been primarily as step-down oral therapy for patients with infection due to C. krusei and fluconazole-resistant and laboratory-confirmed voriconazole-susceptible C. glabrata (Pappas et al., 2016; Pfaller et al., 2007).
The safety of ixekizumab in psoriasis drug therapy
Published in Expert Opinion on Drug Safety, 2020
Mucocutaneous Candida infections are a well-known class effect of IL-17A antagonism; for the most part, they are minor and easily managed, and rarely require treatment discontinuation, but their impact in real world might be higher than in the selected populations of RCTs. This would probably apply to patients with obesity, diabetes mellitus or a history of recurrent oral or genital candidiasis. Esophageal candidiasis is an uncommon occurrence but must be taken into consideration in patients with chest pain or dysphagia. There might be a dose effect, with frequency and severity of mucocutaneous candidiasis increasing with the extent of IL-17 blockade [103]; phase III clinical trials with bimekizumab will probably provide additional evidence of this hypothesis. Since IL-17A plays little role in systemic immunity, unlike TNFα, it is not surprising that a safety signal for opportunistic infections have not been detected with IL-17A antagonists; on the other hand, S. aureus and dermatophyte infections could be expected to occur and might be underreported.
Efficacy and acceptability of different anti-fungal interventions in oropharyngeal or esophageal candidiasis in HIV co-infected adults: a pilot network meta-analysis
Published in Expert Review of Anti-infective Therapy, 2021
Bing-Syuan Zeng, Bing-Yan Zeng, Chao-Ming Hung, Tien-Yu Chen, Yi-Cheng Wu, Yu-Kang Tu, Pao-Yen Lin, Kuan-Pin Su, Brendon Stubbs, Cheuk-Kwan Sun, Yu-Shian Cheng, Dian-Jeng Li, Chih-Sung Liang, Chih-Wei Hsu, Yen-Wen Chen, Ping-Tao Tseng, Chang-Hua Chen
While the commonly recommended treatment to oropharyngeal/esophageal candidiasis is fluconazole, relapse of oropharyngeal or esophageal candidiasis has been gradually increasing in recent decades. To find a new evidence about the advantages of different anti-fungal interventions for managing oropharyngeal or esophageal candidiasis in adults with HIV had become an important issue. Based on network meta-analysis of twenty-seven randomized controlled trials (6277 participants), this work revealed that photosensitizer-based antimicrobial photodynamic therapy (aPDT) with laser irradiation plus methylene blue was associated with the highest cure rate and the lowest relapse rate among the investigated interventions for oropharyngeal candidiasis. However, none of the investigated anti-fungal interventions were superior to fluconazole for esophageal candidiasis in respect of cure rates/relapse rates. In addition, all investigated anti-fungal interventions were well-accepted.
Emerging drugs for eosinophilic esophagitis
Published in Expert Opinion on Emerging Drugs, 2018
Robert D. Pesek, Sandeep K. Gupta
Overall, swallowed corticosteroids appear safe. Esophageal candidiasis can occur in 5–30% and oral candidiasis in approximately 1% of treated patients; however, this is typically an incidental finding during endoscopy and most patients are asymptomatic. Candidiasis can frequently be prevented by attention to drug administration as outlined earlier. There are reports of adrenal gland suppression in both observational and controlled studies [76]. In a systematic review of 17 studies accounting for 596 patients who received swallowed corticosteroids for EoE, adrenal insufficiency was found in 16% [77]. In controlled trials, no statistically significant changes in adrenal function were found between placebo and corticosteroid-treated subjects. Assessment of adrenal suppression also varied widely amongst the included studies making comparison difficult. There are no reports of deleterious effects on linear growth or bone mineral density.
Related Knowledge Centers
- Candida Albicans
- Candidiasis
- Dysphagia
- Odynophagia
- Opportunistic Infection
- Weight Loss
- Esophagus
- Chemotherapy
- Immunodeficiency
- HIV/AIDS