Document 1082
 DOCN  M9591082
 TI    Fluconazole concentrations in saliva from AIDS patients with
       oropharyngeal candidosis refractory to treatment with fluconazole.
 DT    9509
 AU    Garcia-Hermoso D; Dromer F; Improvisi L; Provost F; Dupont B; Unite de
       Mycologie, Institut Pasteur, Paris, France.
 SO    Antimicrob Agents Chemother. 1995 Mar;39(3):656-60. Unique Identifier :
       AIDSLINE MED/95314198
 AB    Fluconazole (FCZ) has been extensively used as a primary therapy for
       oropharyngeal candidosis in AIDS patients. Clinical resistance to FCZ is
       now encountered, often related to decreased susceptibility of the
       isolate in vitro. We wondered if low levels in saliva play a role in the
       therapeutic failure, especially in patients complaining of dry mouth.
       Sixteen AIDS patients treated for oropharyngeal candidosis with FCZ were
       studied. MICs for the isolates were determined. Serum and saliva samples
       were collected to measure FCZ levels with a bioassay using paper disks
       loaded with the clinical specimens. We showed that (i) paper disks were
       convenient for collecting saliva in patients with dry mouth; (ii) levels
       in saliva depended on the FCZ dosage regimen but did not correlate with
       the response to therapy; (iii) correlation between concentrations in
       saliva and serum was poor and independent of clinical response to
       treatment, other therapies, or decreased salivation; and (iv) levels in
       saliva were always lower than MICs in patients who failed to respond to
       treatment. In conclusion, therapeutic failures are more likely to be
       related to in vitro resistance of the isolate to FCZ or insufficient
       dosage regimen than to decreased salivary secretion.
 DE    Acquired Immunodeficiency Syndrome/COMPLICATIONS/*METABOLISM  Adult
       Candida/DRUG EFFECTS  Candidiasis, Oral/DRUG THERAPY/*METABOLISM  Drug
       Resistance, Microbial  Female
       Fluconazole/BLOOD/*PHARMACOKINETICS/THERAPEUTIC USE  Human  Male
       Microbial Sensitivity Tests  Middle Age  Saliva/*METABOLISM  CLINICAL
       TRIAL  JOURNAL ARTICLE

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