Document 0529
 DOCN  M9460529
 TI    Prevention of symptomatic recurrences of esophageal candidiasis in AIDS
       patients after the first episode: a prospective open study.
 DT    9404
 AU    Parente F; Ardizzone S; Cernuschi M; Antinori S; Esposito R; Moroni M;
       Lazzarin A; Porro GB; Department of Gastroenterology, L. Sacco Hospital,
       Milan, Italy.
 SO    Am J Gastroenterol. 1994 Mar;89(3):416-20. Unique Identifier : AIDSLINE
       MED/94168182
 AB    OBJECTIVES: To evaluate the efficacy and safety of low-dose antifungals
       as prophylaxis of recurrent esophageal candidiasis after the first
       episode in patients with AIDS. METHODS: After the first episode of
       esophageal candidiasis, 122 consecutive AIDS patients were randomly
       assigned to two different regimens of continuous long-term antifungal
       prophylaxis (ketoconazole 200 mg or fluconazole 50 mg/day p.o.) or no
       antifungal therapy over a period of 2 yr. Patients were followed up by
       monthly clinical controls and upper GI endoscopy in the case of
       recurrence of esophageal symptoms. RESULTS: One hundred and six patients
       were clinically evaluable over a mean observation time of 7.5 months.
       Prophylaxis with oral antifungals significantly reduced symptomatic
       relapses of esophageal candidiasis, the cumulative probability of
       relapse at 12 months being 38% in the prophylaxis group, compared with
       84% in the untreated group. Both antifungals were sufficiently safe and
       well tolerated. The clinical response of a second episode of candidiasis
       to the reintroduction of standard oral antifungals was markedly worse in
       patients on prophylaxis (especially with ketoconazole) than in untreated
       patients, presumably due to the development of resistance to the
       antifungal. CONCLUSIONS: Continuous prophylaxis with both-fluconazole
       and ketoconazole is effective in preventing recurrences of Candida
       esophagitis in AIDS patients; however, the possible emergence of strains
       resistant to these antifungals, as well as the high cost of the therapy,
       should raise doubts as to whether or not this type of prophylaxis should
       be extended to all AIDS patients with Candida esophagitis, rather than
       to limit its use to specific subgroups of patients, such as those with
       frequent symptomatic relapses.
 DE    Adult  AIDS-Related Opportunistic Infections/EPIDEMIOLOGY/*PREVENTION &
       CONTROL  Candidiasis/EPIDEMIOLOGY/*PREVENTION & CONTROL
       Esophagitis/EPIDEMIOLOGY/*MICROBIOLOGY/*PREVENTION & CONTROL  Female
       Fluconazole/*THERAPEUTIC USE  Follow-Up Studies  Human
       Ketoconazole/*THERAPEUTIC USE  Male  Prospective Studies  Recurrence
       Support, Non-U.S. Gov't  Time Factors  CLINICAL TRIAL  JOURNAL ARTICLE
       RANDOMIZED CONTROLLED TRIAL

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).