L L Patton1, A J Bonito, D A Shugars. 1. Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450, USA. Lauren_Patton@dentistry.unc.edu
Abstract
OBJECTIVE: A systematic review of randomized clinical trials published between 1966 and April 2000 was undertaken to determine the strength of evidence for the effectiveness of antifungal drugs (nystatin, clotrimazole, amphotericin B, fluconazole, ketoconazole, and itraconazole) to prevent and treat oral candidiasis in human immunodeficiency virus-positive patients. STUDY DESIGN: An automated database search identified 366 articles. Six met inclusion and exclusion criteria with respect to prophylaxis; 12 met criteria for treatment of oral candidiasis. RESULTS: The evidence for the prophylactic efficacy of fluconazole is good, although insufficient to draw conclusions about the other antifungals. Evidence for treatment effectiveness is insufficient for amphotericin B but good for nystatin, clotrimazole, fluconazole, ketoconazole, and itraconazole. CONCLUSION: Suggestions for strengthening the evidence base include the following: use of larger, more well-defined groups; control for immunologic status, viral load, history of oral candidiasis, past exposure to antifungals, baseline oral Candida carriage, drug interactions, and antiretroviral therapy; and consistent use of compliance monitors, fungal speciation, and susceptibility testing.
OBJECTIVE: A systematic review of randomized clinical trials published between 1966 and April 2000 was undertaken to determine the strength of evidence for the effectiveness of antifungal drugs (nystatin, clotrimazole, amphotericin B, fluconazole, ketoconazole, and itraconazole) to prevent and treat oral candidiasis in human immunodeficiency virus-positive patients. STUDY DESIGN: An automated database search identified 366 articles. Six met inclusion and exclusion criteria with respect to prophylaxis; 12 met criteria for treatment of oral candidiasis. RESULTS: The evidence for the prophylactic efficacy of fluconazole is good, although insufficient to draw conclusions about the other antifungals. Evidence for treatment effectiveness is insufficient for amphotericin B but good for nystatin, clotrimazole, fluconazole, ketoconazole, and itraconazole. CONCLUSION: Suggestions for strengthening the evidence base include the following: use of larger, more well-defined groups; control for immunologic status, viral load, history of oral candidiasis, past exposure to antifungals, baseline oral Candida carriage, drug interactions, and antiretroviral therapy; and consistent use of compliance monitors, fungal speciation, and susceptibility testing.
Authors: Joel B Epstein; Edmond L Truelove; Kimberly Hanson-Huggins; Lloyd A Mancl; Alice Chen; Oliver W Press; Stephen H Petersdorf; Thomas R Fritsche; Joshua D Epstein Journal: Support Care Cancer Date: 2004-04-24 Impact factor: 3.603
Authors: Pranab K Mukherjee; Huichao Chen; Lauren L Patton; Scott Evans; Anthony Lee; Johnstone Kumwenda; James Hakim; Gaerolwe Masheto; Frederick Sawe; Mai T Pho; Kenneth A Freedberg; Caroline H Shiboski; Mahmoud A Ghannoum; Robert A Salata Journal: AIDS Date: 2017-01-02 Impact factor: 4.177