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1.
Braz. J. Pharm. Sci. (Online) ; 58: e18719, 2022. tab, graf
Article in English | LILACS | ID: biblio-1364412

ABSTRACT

Abstract The aim of present study was calculate the Minimum inhibitory concentrations (MICs) of silver nanoparticles and clotrimazole for Candida species and their interaction by the adaptation of standarized methods. The MICs values of clotrimazole were 9 E-04-3 E-03 ug/ml, 0.1-0.6 ug/ml, 3 E-03- 0.1 ug/ml and 3 E-03-0.3 ug/ml for Candida albicans susceptible to fluconazole, Candida albicans resistance to fluconazole, Candida krusei and Candida parapsilosis respectively. The MICs values of silver nanoparticles were 26.50- 53 ug/ml; 26.50-106 ug/ml; 106-212 ug/ ml and 26.50- 53 ug/ml for Candida albicans susceptible to fluconazole, Candida albicans resistance to fluconazole, Candida krusei and Candida parapsilosis respectively. Synergism between clotrimazole and silver nanoparticles was measured by checkerboard BMD (broth microdilution) test and shown only for C. albicans susceptible to fluconazole because the fractional inhibitory concentrations (FICs) values were 0.07 - 0.15 ug/ml. Indifference was shown for the other species tested because the FICs values were between 0.5 - 2- 3.06 ug/ml. The results suggest synergistic activity depending on the fungus species analysed, however we recommend the incorporation of others measurement methodologies to confirm our results. As for measurement methodologies of MICs of silver nanoparticles and clotrimazole international normative were respected to guarantee reproducible and comparable results.


Subject(s)
Candida/classification , Clotrimazole/analogs & derivatives , Nanoparticles/administration & dosage , Antifungal Agents/adverse effects , Microbial Sensitivity Tests/instrumentation , Fungi
2.
Rev. chil. infectol ; 36(4): 403-413, ago. 2019. tab
Article in Spanish | LILACS | ID: biblio-1042655

ABSTRACT

Resumen La enfermedad fúngica invasora (EFI) es una entidad que afecta pacientes inmunocomprometidos y críticamente enfermos. En los últimos años, el número de pacientes con riesgo de presentarla viene en aumento, con el consecuente incremento de la formulación de antifúngicos de manera profiláctica, anticipada o empírica. Algunos estudios que evaluaron el uso adecuado de antifúngicos han mostrado que hasta 72% de las formulaciones pueden ser inapropiadas, exponiendo a los pacientes al riesgo de efectos adversos e interacciones medicamentosas, con mayores costos de la atención. Se han recomendado diferentes intervenciones para el control y el uso racional de antimicrobianos, conocidas como "antimicrobial stewardship", las que se pueden aplicar al uso de antifúngicos denominándose "antifungal stewardship"". Se presenta una revisión de la literatura médica sobre el uso apropiado de antifúngicos y el impacto de la implementación de programas de optimización del uso de estos medicamentos en algunos centros.


Invasive fungal disease (IFD) is a condition affecting immunosuppressed and critically ill patients. Recently there has been an increase in the amount of patients at risk for IFD, which implies an increase in the prescription of antifungal agents as prophylactic, pre-emptive or empiric therapy. Some studies evaluating appropriateness of antifungal prescription have shown that inappropriate formulations reach 72%, exposing patients to side effects, pharmacological interactions and rising costs. Some groups have recommended many interventions to control and make a rational use of antimicrobials, into strategies known as "antimicrobial stewardship", these interventions are useful also for antifungal agents and it has been named "antifungal stewardship". Here we present a narrative review of the scientific literature showing published articles about appropriate use of antifungal agents and the experience of some centers after implementing antifungal stewardship programs.


Subject(s)
Humans , Inappropriate Prescribing/prevention & control , Invasive Fungal Infections/drug therapy , Antimicrobial Stewardship/methods , Antifungal Agents/administration & dosage , Antifungal Agents/adverse effects , Immunocompromised Host , Drug Monitoring , Inappropriate Prescribing/statistics & numerical data , Invasive Fungal Infections/diagnosis
3.
Braz. J. Pharm. Sci. (Online) ; 55: e17479, 2019. tab
Article in English | LILACS | ID: biblio-1039040

ABSTRACT

The aim of this study was to evaluate the antifungal susceptibility patterns of three antifungals, methanolic extracts and N-hexane oil of sesame seeds on C. albicans and C. glabrata, isolated from oral cavity of liver transplant recipients. The results were compared with other reports to develop a mini review as well. Candida species were isolated from liver transplant recipients. To evaluate the antifungal activity of sesame seed oil and methanolic extract, fluconazole, caspofungin and nystatin, the corresponding minimum inhibitory concentrations were determined by CLSI M27-A3 standard method. Minimum fungicidal concentration was also evaluated. The most prevalent species was C. albicans, followed by C. glabrata. Findings indicated sensitivity to antifungal agents and resistance to methanolic extract and N-hexane oil for all C. albicans and C. glabrata isolates. The rate of Candida colonization in the oral cavity of liver transplant recipients was high. Our results revealed that the methanolic and N-hexan extracts of sesame seeds are not effective on C. albicans and C. glabrata species, isolated from the patients. The sesame seed oil pulling and mouthwash cannot effectively cleanse and remove the Candida species in the mouth. Investigation of other medicinal plants or other parts of sesame like leaves and roots are suggested.


Subject(s)
Oils, Volatile/analysis , Sesamum/anatomy & histology , Antifungal Agents/adverse effects , Candida/immunology , Liver Transplantation
4.
Rev. méd. Chile ; 146(12): 1481-1485, dic. 2018. graf
Article in Spanish | LILACS | ID: biblio-991360

ABSTRACT

We report a 45-year-old male with AIDS who had a Cryptococcus neoformans central nervous system infection. He was treated with amphotericin B deoxycholate subsequently changed to voriconazole due to systemic toxicity of the former. Plasma levels of voriconazole were insufficient with a standard dose (0.7 μg/mL), therefore, the dose was increased thereafter to reach appropriate levels (4.5 μg/mL). Anti-retroviral therapy was started five weeks after voriconazole initiation with non-interacting drugs and he was discharged after a favorable evolution. He was re-admitted three months later due to seizures; a brain magnetic resonance showed new sub-cortical nodules. After excluding alternative causes and demonstrating fungal eradication, an immune reconstitution inflammatory syndrome (IRIS) event was suspected and treated with a short course of steroids. His evolution was satisfactory.


Subject(s)
Humans , Male , Middle Aged , Amphotericin B/adverse effects , Meningitis, Cryptococcal/drug therapy , AIDS-Related Opportunistic Infections/drug therapy , Deoxycholic Acid/adverse effects , Immune Reconstitution Inflammatory Syndrome/chemically induced , Voriconazole/administration & dosage , Antifungal Agents/adverse effects , Amphotericin B/administration & dosage , Meningitis, Cryptococcal/diagnostic imaging , AIDS-Related Opportunistic Infections/diagnostic imaging , Deoxycholic Acid/administration & dosage , Drug Combinations , Antifungal Agents/administration & dosage
5.
Rev. Ciênc. Méd. Biol. (Impr.) ; 17(3): 315-321, nov 19, 2018. tab, ilus
Article in Portuguese | LILACS | ID: biblio-1247693

ABSTRACT

Introdução: a candidíase é uma infecção fúngica oportunista, causada pela proliferação e disseminação de espécies de Candida, que pode acometer a cavidade oral. Dentre os antifúngicos mais utilizados e de uso tópico, a nistatina é considerada o medicamento de primeira escolha. Objetivo: avaliar as propriedades físico-químicas de diferentes marcas de nistatina disponíveis no mercado, incluindo o pH, a acidez total titulável (ATT) e a determinação de sólidos solúveis totais (SST). Metodologia: trata-se de um estudo experimental in vitro, constituído por uma amostra de oito diferentes marcas de nistatina em suspensão oral de uso tópico. Foi analisado o potencial erosivo e cariogênico dessas soluções mediante a determinação de pH, ATT e SST (°Brix). Resultados: no tocante ao pH, verificou-se que a média obtida foi de 6,05 (± 0,66). Dois dos medicamentos analisados (marcas A e H) apresentaram pH abaixo do crítico para a dissolução do esmalte dental. Quanto à ATT das soluções, os valores variaram de 1,9 a 14,53 mL para atingir o pH neutro, indicando que as marcas B, C e E podem levar mais tempo para ser neutralizadas em razão da quantidade de solução necessária. A análise do °Brix revelou que a marca H apresentou o maior teor de açúcares em sua composição (44,9%). Conclusão: a formulação de nistatina da marca H apresentou pH endógeno mais crítico e percentual de sólidos solúveis totais elevado, sendo, portanto, a medicação com maior fator de risco para o desenvolvimento de cárie e erosão dentária, devendo ser consideradas as doses e frequências de uso, bem como os hábitos de higiene oral do paciente


Introduction: candidiasis is an opportunistic fungal infection caused by the proliferation and spread of Candida species that can affect the oral cavity. Among the most commonly used topical antifungal agents, nystatin is considered the first choice drug. Methodology: to evaluate the physical and chemical properties of different brands of nystatin available in the market, including pH, titratable acidity and determination of total soluble solids. Results: Regarding pH, it was verified that the mean obtained was 6.05 (± 0.66). Two of the analyzed drugs (A and H) presented pH below that considered critical for the dissolution of dental enamel. As for the titratable total acidity of the solutions, values ranged from 1.9 to 14.53 mL to reach neutral pH, indicating that the B, C and E marks may take longer to neutralize because of the amount of solution required. The analysis of ° Brix revealed that the H mark had the highest sugar content in its composition (44.9%). Conclusion: Nystatin brand H presented the worst indices in terms of endogenous pH and total sugar percentage, being therefore the medication with the highest risk factor for the development of caries and dental erosion.


Subject(s)
Tooth Erosion/chemically induced , Candidiasis, Oral/drug therapy , Cariogenic Agents/analysis , Nystatin/adverse effects , Antifungal Agents/adverse effects
6.
Braz. j. biol ; 78(4): 673-678, Nov. 2018. tab, graf
Article in English | LILACS | ID: biblio-951612

ABSTRACT

Abstract Amphotericin B is a fungicidal substance that is treatment of choice for most systemic fungal infections affecting immunocompromised patients. However, severe side effects have limited the utility of this drug. The aim of this study was to evaluate the antifungal effect of the combination of amphotericin B with black tea or white tea and protective of citotoxic effect. The present study shows that white and black teas have additive effects with amphotericin B against some species Candida. In addition, the combination of white and black tea with amphotericin B may reduce the toxicity of amphotericin B to red blood cells. Our results suggest that white and black tea is a potential agent to combine with amphotericin for antifungal efficacy and to reduce the amphotericin dose to lessen side effects.


Resumo A anfotericina B é o tratamento de escolha para a maioria das infecções fúngicas sistémicas que afetam os doentes imunocomprometidos. No entanto, efeitos secundários graves têm limitado a utilidade desta droga. O objetivo deste estudo foi avaliar o efeito antifúngico da combinação de anfotericina B com chá preto ou chá branco, bem como o efeito citotóxico desta combinação sobre hemáceas. O presente estudo demonstra que o chá branco e preto de Camellia sinensis têm efeitos aditivos com anfotericina B contra algumas espécies de Candida sp. Além disso, a combinação de chá branco e preto com anfotericina B pode reduzir a toxicidade da anfotericina B em hemáceas. Nossos resultados sugerem que o chá branco e preto são agentes potenciais para associação com anfotericina B contribuindo para eficácia antifúngica, bem como redução de toxicidade.


Subject(s)
Humans , Candida/drug effects , Amphotericin B/pharmacology , Camellia sinensis/adverse effects , Erythrocytes/drug effects , Antifungal Agents/pharmacology , Amphotericin B/adverse effects , Hemolysis/drug effects , Antifungal Agents/adverse effects
7.
Arch. argent. pediatr ; 116(3): 451-454, jun. 2018. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-950025

ABSTRACT

La información sobre el uso de posaconazol en niños es escasa. Se realizó este estudio descriptivo retrospectivo entre agosto de 2010 y marzo de 2017 para evaluar las características clínicas, microbiológicas y la evolución de los pacientes tratados con posaconazol. Se incluyeron 16 niños. Mediana de edad: 161 meses (rango intercuartílico -RIC- 69-173 m). Todos tenían enfermedad subyacente y presentaban infección fúngica invasiva probada. Los aislamientos más frecuentes fueron Mucor spp. y Aspergillus spp. La dosis media de posaconazol fue 600 mg/día (400-800 mg/día) y la mediana de duración del tratamiento, 223 días (RIC 48-632). Diez pacientes presentaron efectos adversos, pero solo uno requirió suspensión del antifúngico debido a alteraciones hidroelectrolíticas.


There is limited information on the use of posaconazole in children. This retrospective and descriptive study was conducted to evaluate the clinical, microbiological characteristics and evolution of patients treated with posaconazole between August 2010 and March 2017. We included 16 children. Median age: 161 months (interquartile range -IQR-69-173m). All had underlying disease and a proven invasive fungal infection. The most frequent isolated were Mucor spp. and Aspergillus spp. The mean posaconazole dose was 600 mg /day (400-800 mg/day) and the median duration of treatment was 223 days (IQR 48-632). Ten patients had adverse effects, but only one required suspension of the antifungal treatment due to hydroelectrolytic disorders.


Subject(s)
Humans , Child, Preschool , Child , Adolescent , Triazoles/therapeutic use , Invasive Fungal Infections/drug therapy , Antifungal Agents/therapeutic use , Time Factors , Triazoles/administration & dosage , Triazoles/adverse effects , Retrospective Studies , Dose-Response Relationship, Drug , Tertiary Care Centers , Invasive Fungal Infections/microbiology , Hospitals, Pediatric , Antifungal Agents/administration & dosage , Antifungal Agents/adverse effects
8.
São José dos Campos; s.n; 2018. 39 p. il., tab., graf..
Thesis in Portuguese | LILACS, BBO | ID: biblio-911225

ABSTRACT

A estomatite protética é uma das afecções mais comuns e recorrentes em pacientes portadores de próteses totais. O fungo do gênero Candida, promotor dessa patologia, além de resistente se torna ainda mais complexo de ser combatido devido à dificuldade da ação de fármacos tópicos que só conseguem permanecer por um curto período no local da infecção, em virtude da dinâmica da cavidade bucal. O processo de Solution Blow Spinning permite a obtenção de fibras ultrafinas que podem ser aplicadas em vastas áreas, inclusive na bioengenharia. Uma das aplicabilidades das fibras ultrafinas é sua utilização para liberação controlada de fármacos de forma eficiente e duradoura. Dessa forma, o intuito do presente trabalho foi incorporar Cinamaldeído (CA), composto que possui propriedades antimicrobianas, a mantas de Poli(ácido lático) e Poli(etileno glicol) (PLA/PEG) e avaliá-las quanto à produção e caracterização por, Microscopia eletrônica de varredura (MEV), Mensuração do ângulo de contato, Termogravimetria (TGA), Calorimetria Exploratória Diferencial (DSC), Espectroscopia de infravermelho por transformada de Fourier (FTIR), Espectroscopia no ultravioleta visível (UV/vis), ensaios mecânicos e ação antifúngica. Para realização dos experimentos, foram fiadas as seguintes mantas: PLA, PLA/PEG e PLA/PEG 23,8% CA. As micrografias obtidas por MEV mostraram, que os diâmetros das fibras que não continham CA, apresentaram diâmetros semelhantes entre si, PLA (354±160 nm)a e PLA/PEG (428±250nm)a , sendo esses diâmetro menores dos que encontrados nas fibras de PLA/PEG 23,8% CA (749±370 nm)b . O ângulo de contato e tensão superficial não puderam ser verificados em virtude da proporção de polímeros nas blendas que apresentaram alta afinidade pelos solventes utilizados no teste. No ensaio de TGA, a curva de PLA/PEG com acréscimo de 23,8% CA exibiu uma maior estabilidade térmica. No teste de DSC o ponto de transição vítrea das mantas contendo 23,8% CA foi o que apresentou menor valor. A liberação de CA foi satisfatória ocorrendo até o 6° dia. No teste de ensaios mecânicos, o acréscimo de CA às mantas aumentaram significativamente o Módulo elástico (24,94±4,45) e a Tensão máxima de ruptura (0,99±0,16 MPa) com relação às mantas puras de PLA/PEG (18,74±3.41 MPa) and (0,85±0.09 MPa), esse acréscimo ainda promoveu redução estatisticamente significante (p˂ 0,05%) em mais de 50% nos biofilmes monotípicos de C. albicans e C. krusei e no multiespécie de C. albicans, C. krusei e C. glabrata. Mediante os resultados encontrados pode-se depreender que é possível se obter mantas de fibras ultrafinas de PLA/PEG contendo 23,8% de CA com propriedades antifúngicas e capacidade de liberação do agente antimicrobiano por cerca de 12 dias(AU)


Denture stomatitis is one of the most common and recurrent conditions in patients with total dentures. The fungal of the genus Candida, the causer of this pathology, besides being resistant, becomes even more complex to be combated due to the difficulty of the action of topical drugs that can only remain for a short time at the site of infection due to the dynamic of the oral cavity. The Solution Blow Spinning process allows the production of ultrafine fibers that can be applied in large areas, including bioengineering. One of the applications of ultrafine fibers is their use for controlled release of drugs in an efficient and long-lasting manner. Thus, the aim of the present work was to incorporate Cinnamaldehyde (CA), a compound that has antimicrobial properties, to Poly (lactic acid) and Poly (ethylene glycol) blankets (PLA / PEG) and to evaluate them for the production and characterization by Scanning Electron Microscopy (SEM), Contact Angle Measurement Thermogravimetric (TGA), Differential Scanning Calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR), Ultraviolet­visible (UV/vis) spectroscopy, mechanical properties and antifungal action. Antifungal activity was verified against C. albicans, C. krusey and C. glabrata by broth microdilution test, disk diffusion and anti-biofilm activity, in both multi-species and mono-species biofilms. For the experiment, three types of meshes were spun: pure PLA, PLA/PEG and PLA / PEG 23.8% CA. The micrographs obtained by SEM showed that the fibers that did not contain CA had similar diameters to each other and smaller than the fibers containing PLA / PEG 23, 8% CA. The contact angle and surface tension could not be measured by virtue of the proportion of polymers in the blends which showed high affinity for the solvents used in the test. In the TGA assay, the PLA/PEG curve with 23.8% CA increase exhibited a higher thermal stability while in the DSC test the glass transition point of the meshes containing 23.8% CA it was the one with the lowest value. The release of CA was satisfactory occurring until the 6 th day. PLA membranes with fibres of diameter exhibited the lowest fibre diameter (354 ±160 nm)a followed by PLA/PEG (428±250nm)a and PLA/PEG/CA (749±370 nm)b . Addition of CA resulted in an increase in mechanical properties of the membranes from (24.94±4.85 MPa) the elastic modulus and (0.99±0.16 MPa) tensile strength in comparison to PLA/PEG (18.74±3.41 MPa) and (0,85±0.09 MPa). CA incorporation increased improved the thermal stability, with release of CA of 0.10 µg/mL over a 6 days period. The PLA/PEG CA membranes presented antifungal activities, showing reductions in more than 50% of the biofilm biomass, being statistically significant (p<0.05%) to the control group. Fibrous membranes of PLA/PEG/CA ultrathin fibres were produced by SBS that exhibited antifungal properties and release over a 12-day period(AU)


Subject(s)
Humans , Candida , Antifungal Agents , Antifungal Agents/adverse effects , Biocompatible Materials
9.
Rev. Nac. (Itauguá) ; 10(1): 17-35, 20180600.
Article in Spanish | LILACS, BDNPAR | ID: biblio-914219

ABSTRACT

Introducción En las últimas décadas, el agente de elección para el tratamiento de la mayoría de las micosis sistémicas ha sido la anfotericina B que, a pesar de los efectos tóxicos, sigue teniendo un papel importante en el tratamiento de las infecciones micóticas. Objetivo Determinar los efectos adversos asociados al empleo de anfotericina B en neonatos del Servicio de Neonatología del Hospital Nacional de Itauguá, en el periodo 2013 - 2015. Materiales y métodos Estudio de serie de casos, retrospectivo, de recién nacidos con tratamiento con anfotericina B. Resultados: Entre 28 recién nacidos tratados con anfotericina B, hubo mayor prevalencia en el sexo masculino. Con respecto a la edad más de la mitad de los recién nacidos fueron pre-término en el grupo estudiado. Hubo predominio de bajo peso al nacer (32,14%). Los factores de riesgo arrojaron que 53,5% no contaba con antecedentes de sepsis. La edad media de inicio de anfotericina fue 19±9 días, más de la mitad de los neonatos utilizó dosis progresiva de 0,5 mg/kp/día a 1 mg/kp/día, en 24 hs.El 96,4% recibió infusión de anfotericina B de 4 horas, 1 caso requirió 6 horas. Entre los efectos secundarios, 35,7% de los pacientes presentó anemia, el disturbio hidroelectrolítico más frecuente fue la hipokalemia, entre los signos se destacaron la taquicardia e hipotensión. Conclusiones Los efectos secundarios más llamativos encontrados durante el tratamiento con anfotericina B fueron la anemia, alteraciones de Sodio y Potasio


Introduction In recent decades, the agent of choice for the treatment of most systemic mycoses has been amphotericin B which, despite the toxic effects, continues to play an important role in the treatment of fungal infections. Objective To determine the adverse effects associated with the use of amphotericin B in neonates of the Neonatology Service of the National Hospital of Itauguá, in the period 2013 - 2015. Materials and methods: retrospective case series study of newborns treated with amphotericin B. Results Among 28 newborns treated with amphotericin B, there was a higher prevalence in males. With regard to age, more than half of the newborns were pre-term in the group studied. There was a predominance of low birth weight (32.14%). The risk factors showed that 53.5% did not have a history of sepsis. The mean age of onset of amphotericin was 19 ± 9 days, more than half of the infants used progressive dose from 0.5 mg / kp / day to 1 mg / kp / day, in 24 hours. 96.4% received infusion of amphotericin B for 4 hours, 1 case required 6 hours. Among the side effects, 35.7% of the patients presented anemia, the most frequent water and electrolyte disturbance was hypokalemia, among the signs were tachycardia and hypotension. Conclusions The most striking side effects found during treatment with amphotericin B were anemia, Sodium and Potassium alterations.


Subject(s)
Humans , Male , Female , Infant, Newborn , Amphotericin B/adverse effects , Deoxycholic Acid/adverse effects , Mycoses/drug therapy , Antifungal Agents/adverse effects , Infant, Low Birth Weight , Infant, Premature , Amphotericin B/administration & dosage , Retrospective Studies , Deoxycholic Acid/administration & dosage , Antifungal Agents/administration & dosage
10.
Evid. actual. práct. ambul ; 19(3): 93-93, 2016.
Article in Spanish | LILACS | ID: biblio-1151764

ABSTRACT

El posaconazol es un antifúngico de amplio espectro de la familia de los triazólicos que se utiliza en el tratamiento y profilaxis de infecciones micóticas invasivas en pacientes de 13 años de edad o mayores, en las cuales otros tratamientos no han sido eficaces o tolerados. En junio de 2016 la Agencia Europea de Medicamentos y la Agencia Española de Medicamentos y Productos Sanitarios emitieron un alerta donde advierten que debido a diferencias en la frecuencia de dosificación, interacción con los alimentos y en los niveles plasmáticos alcanzados por el medicamento, los comprimidos y la suspensión de posaconazol no son intercambiables. (AU)


Posaconazole is a broad-spectrum triazole family antifungal used in the treatment and prophylaxis of invasive fungal infections in patients 13 years of age or older, in which other treatments have not been effective or tolerated. In June 2016 the European Medicines Agency and the Spanish Agency for Medicines and Health Products issued a warning alerting that because of differences in the frequency of dosing, interactions with food and plasma levels achieved by the drug, tablets and posaconazole suspension are not interchangeable. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Triazoles/pharmacokinetics , Antifungal Agents/pharmacokinetics , Triazoles/administration & dosage , Triazoles/adverse effects , Administration, Oral , Medication Errors , Mycoses/drug therapy , Antifungal Agents/administration & dosage , Antifungal Agents/adverse effects
11.
Article in English | WPRIM | ID: wpr-200225

ABSTRACT

We assessed the success rate of empirical antifungal therapy with itraconazole and evaluated risk factors for predicting the failure of empirical antifungal therapy. A multicenter, prospective, observational study was performed in patients with hematological malignancies who had neutropenic fever and received empirical antifungal therapy with itraconazole at 22 centers. A total of 391 patients who had abnormal findings on chest imaging tests (31.0%) or a positive result of enzyme immunoassay for serum galactomannan (17.6%) showed a 56.5% overall success rate. Positive galactomannan tests before the initiation of the empirical antifungal therapy (P=0.026, hazard ratio [HR], 2.28; 95% confidence interval [CI], 1.10-4.69) and abnormal findings on the chest imaging tests before initiation of the empirical antifungal therapy (P=0.022, HR, 2.03; 95% CI, 1.11-3.71) were significantly associated with poor outcomes for the empirical antifungal therapy. Eight patients (2.0%) had premature discontinuation of itraconazole therapy due to toxicity. It is suggested that positive galactomannan tests and abnormal findings on the chest imaging tests at the time of initiation of the empirical antifungal therapy are risk factors for predicting the failure of the empirical antifungal therapy with itraconazole. (Clinical Trial Registration on National Cancer Institute website, NCT01060462)


Subject(s)
14-alpha Demethylase Inhibitors/adverse effects , Adolescent , Adult , Aged , Antifungal Agents/adverse effects , Aspergillosis/complications , Candidiasis/complications , Coccidioidomycosis/complications , Febrile Neutropenia/complications , Female , Hematologic Neoplasms/complications , Humans , Itraconazole/adverse effects , Male , Mannans/blood , Middle Aged , Prospective Studies , Treatment Outcome , Young Adult
12.
Yonsei Medical Journal ; : 9-18, 2014.
Article in English | WPRIM | ID: wpr-188829

ABSTRACT

PURPOSE: To identify prognostic factors for the outcomes of empirical antifungal therapy, we performed a multicenter, prospective, observational study in immunocompromised patients with hematological malignancies. MATERIALS AND METHODS: Three hundred seventy-six patients (median age of 48) who had neutropenic fever and who received intravenous (IV) itraconazole as an empirical antifungal therapy for 3 or more days were analyzed. The patients with possible or probable categories of invasive fungal disease (IFD) were enrolled. RESULTS: The overall success rate was 51.3% (196/376). Age >50 years, underlying lung disease (co-morbidity), poor performance status [Eastern Cooperative Oncology Group (ECOG) > or =2], radiologic evidence of IFD, longer duration of baseline neutropenic fever (> or =4 days), no antifungal prophylaxis or prophylactic use of antifungal agents other than itraconazole, and high tumor burden were associated with decreased success rate in univariate analysis. In multivariate analysis, age >50 years (p=0.009) and poor ECOG performance status (p=0.005) were significantly associated with poor outcomes of empirical antifungal therapy. Twenty-two patients (5.9%) discontinued itraconazole therapy due to toxicity. CONCLUSION: We concluded that empirical antifungal therapy with IV itraconazole in immunocompromised patients is effective and safe. Additionally, age over 50 years and poor performance status were poor prognostic factors for the outcomes of empirical antifungal therapy with IV itraconazole.


Subject(s)
Antifungal Agents/adverse effects , Female , Hematologic Neoplasms , Humans , Immunocompromised Host , Itraconazole/adverse effects , Male , Middle Aged , Prospective Studies , Republic of Korea
13.
Yonsei Medical Journal ; : 1234-1240, 2013.
Article in English | WPRIM | ID: wpr-74278

ABSTRACT

PURPOSE: Posaconazole is a second-generation triazole with a broad spectrum. However, there is a lack of data to support a significant role for posaconazole in the treatment of invasive fungal infection (IFI), especially in Korea. Until recently, posaconazole was available only through the Korean Orphan Drug Center. This study was designed to review the use of posaconazole at a single-center in Korea. MATERIALS AND METHODS: Data from patients who received posaconazole treatment at Catholic Blood and Marrow Transplantation Center were retrospectively reviewed between January 2007 and September 2012. RESULTS: A total of 11 cases (3 males and 8 females, median age 52 years) received posaconazole. Five patients were given the drug for mucormycosis, two for invasive aspergillosis, and four for unspecified IFI for which galactomannan (GM) assays were negative. The treatment duration ranged from 4-250 days. Three patients received posaconazole for management refractory IFI, two for intolerance of previous antifungal therapy, and six for long-term maintenance treatment. The overall successful response rate to posaconazole was 55% (six of eleven patients). Five of eleven patients died during the study period. However, only one death was attributed to the progression of IFI. None of the patients discontinued posaconazole therapy due to adverse events. CONCLUSION: Posaconazole is an attractive oral antifungal agent for salvage treatment of IFI, particularly upon diagnosis of mucormycosis or in cases in which mucormycosis cannot be ruled out due to a negative GM.


Subject(s)
Adult , Aged , Antifungal Agents/adverse effects , Female , Humans , Immunocompromised Host , Male , Middle Aged , Mucormycosis/drug therapy , Mycoses/drug therapy , Republic of Korea , Salvage Therapy/adverse effects , Triazoles/adverse effects
14.
Rev. cuba. estomatol ; 49(2): 99-106, abr.-jun. 2012.
Article in Portuguese | LILACS, CUMED | ID: lil-639759

ABSTRACT

A utilização de produtos naturais na odontologia tem se mostrado como uma fonte alternativa no combate às patologias orais, incluindo as infecções fúngicas, causadas, geralmente, por Candida spp. Avaliar a ação antifúngica de tinturas de própolis Apis milifera e romã Punica granatum sobre Candida albicans (ATCC 76618), Candida krusei (ATCC 6538) e Candida tropicalis (ATCC 13803). A ação antifúngica das tinturas foi avaliada pelo método da Concentração Inibitória Mínima em meio de cultura sólido Ágar Saburaud Dextrose (Difco®). Foram confeccionados poços, com 6 mm de diâmetro, destinados a inserção de 50 µL das tinturas. Foram avaliadas seis concentrações seriadas das tinturas, sendo a concentração inicial para a tintura de própolis 200 mg/mL e 300 mg/mL a concentração inicial para a tintura de romã. Posteriormente, as placas de Petri foram incubadas em estufa bacteriológica por 48 h a 37 ºC. A análise dos dados para a Concentração Inibitória Mínima foi feita através da mensuração dos halos de inibição, sendo considerados quando iguais ou superiores a 10 mm de diâmetro. Para a tintura de romã observou-se que as Concentração Inibitória Mínima sobre Candida albicans, Candida krusei e Candida tropicalis foram 9,37 mg/mL, 9,37 mg/mL e 18,75 mg/mL, respectivamente. Em relação à tintura da própolis, constatou-se que apenas em sua forma pura apresentou ação antifúngica sobre Candida krusei e Candida tropicalis, entretanto a mesma ação não foi observada sobre Candida albicans. As tinturas avaliadas apresentam ação antifúngica sobre as cepas avaliadas, exceto a tintura da própolis sobre Candida albicans(AU)


Se ha demostrado que el uso de productos naturales en Estomatología es una fuente alternativa contra las enfermedades orales, incluyendo las infecciones micóticas, generalmente causadas por Candida spp. El objetivo de este trabajo fue evaluar la acción antimicótica de las tinturas a partir del propóleo (Apis milifera) y a partir de pomegranate (Punica granatum) sobre Candida albicans (ATCC 76618), Candida krusei (ATCC 6538) y Candida tropicalis (TCC 13803). La actividad antimicótica de las tinturas fue evaluada por el método Minimum Inhibitory Concentration en Aagar Dextrosa Saburaud (Difco®). Se crearon 6 orificios con un diámetro de 6 mm para la inserción de 50 µL de tinturas. Se evaluaron 6 concentraciones seriadas donde la concentración inicial para las tinturas a partir de propóleo fue de 200 mg/mL y de 300 mg/mL como concentración inicial para la tintura a partir de pomegranate. Posteriormente, los discos de Petri fueron incubados durante 48 h a 37ºC. El análisis de los datos para Minimum Inhibitory Concentration fue realizado midiendo las zonas de inhibición, se consideró inhibición cuando es igual o mayor de 10 mm de diámetro. En el caso de la tintura de pomegranate, se comprobó que la Minimum Inhibitory Concentration en Candida albicans, Candida krusei y Candida tropicalis fueron de 9,37 mg/mL, 9,37 mg/mL y 18,75 mg/mL respectivamente. Para las tinturas a base de propóleo, la acción antimicótica fue verificada solo en la concentración pura sobre Candida krusei y Candida tropicalis, pero no fue observada en Candida albicans. Las tinturas a base de pomegranate y propóleo tuvieron actividad antimicótica sobre las cepas evaluadas, excepto en el caso de la tintura a base de propóleo sobre Candida albicans(AU)


The use of natural products in Dentistry has been shown as an alternative source against oral diseases, including fungi infections, generally caused by Candida spp. The aim was to evaluate the antifungal action of tinctures from propolis (Apis milifera) and from pomegranate (Punica granatum) on Candida albicans (ATCC 76618), Candida krusei (ATCC 6538) and Candida tropicalis (ATCC 13803). The antifungal activity of tinctures was evaluated by Minimum Inhibitory Concentration method on Saburaud Dextrose Agar (Difco®). Six wells were confectioned, with 6 mm of diameter, to the insertion of 50 µL of tinctures. Six serial concentrations were evaluated, been 200 mg/mL the initial concentration for tincture from propolis and 300 mg/mL the initial concentration for tincture from pomegranate. Later, the Petri plates were incubated in bacteriological incubator for 48 h on 37 ºC. Data analysis for Minimum Inhibitory Concentration was conducted by measurement of inhibition zones, been considered inhibited when equal or bigger than 10 mm of diameter. For tincture from pomegranate, was verified that the Minimum Inhibitory Concentration on Candida albicans, Candida krusei and Candida tropicalis were 9.37 mg/mL, 9.37 mg/mL and 18.75 mg/mL, respectively. For tinctures from propolis, the antifungal action was verified only in pure concentration on Candida krusei and Candida tropicalis, but it was not observed on Candida albicans. The tinctures from pomegranate and propolis had antifungal activity on evaluated strains, except for tincture from propolis on Candida albicans(AU)


Subject(s)
Humans , Pharmaceutic Aids/analysis , Candida albicans/pathogenicity , Antifungal Agents/adverse effects
15.
Indian J Cancer ; 2012 Jan-Mar; 49(1): 107-113
Article in English | IMSEAR | ID: sea-144560

ABSTRACT

Background: In patients with persistent fever and netropenia, amphotericin B is administered empirically for early treatment and prevention of systemic fungal infections. Despite this treatment, there are chances of breakthrough fungal infections and drug is also toxic. Materials and Methods: A multicentric, randomized, controlled clinical trial was conducted to compare liposomal amphotericin B two doses with conventional amphotericin B as empirical antifungal therapy. Results: The average body weight of patients was 26.4±14.8 (n=22), 32.9±19.4 (n=23) and 37.9±20.0 (n=20) kg in 1 mg, 3 mg Fungisome (liposomal amphotericin B) and 1 mg/kg/day conventional amphotericin B group, respectively. The mean age was 16.2±13.4, 16.0±10.9 and 22.7±16.2 yrs in 1 and 3 mg/kg/day Fungisome and 1 mg/kg/day conventional AMP B group, respectively. The average duration of treatment with 1 mg and 3 mg/kg/day Fungisome and 1 mg/kg/day conventional amphotericin B was 17±9.8, 16.2±8.3, and 14.7±10.7 days, respectively. The time to resolve fever was 13.3±10.2, 10.9±7.1, 10.1±6.7 days, and for absolute neutrophil count (ANC) to be above 500 cells per microliter, it took 13.4±9.6, 10.6±7.6 and 7.3±3.4 days, respectively. Liposomal formulations were well-tolerated compared to conventional amphotericin B. Conclusions: This small randomized study showed that the indigenous liposomal formulation Fungisome TM appears to be equally efficacious and safer than conventional amphotericin B. Also, the lower dose Fungisome (1 mg/kg/day) appears to be equally efficacious and was well-tolerated as compared to higher dose Fungisome (3 mg/kg/day). Treatment cost would be a major factor for limiting use of higher dose of Fungisome.


Subject(s)
Adolescent , Adult , Amphotericin B/administration & dosage , Amphotericin B/adverse effects , Antifungal Agents/administration & dosage , Antifungal Agents/adverse effects , Child , Child, Preschool , Dose-Response Relationship, Drug , Female , Humans , India , Male , Middle Aged , Mycoses/drug therapy , Neutropenia/drug therapy , Neutropenia/pathology , Safety , Treatment Outcome
16.
Univ. sci ; 16(3): 294-302, sept.-dic. 2011.
Article in Spanish | LILACS | ID: lil-619196

ABSTRACT

Objetivo. Sintetizar y realizar la evaluación preliminar de la actividad antifúngica in vitro de oximas, éteres de oxima e isoxazoles. Materiales y métodos. Las oximas se sintetizaron a partir de aldehídos o cetonas con NH2OH.HCl y K2CO3. Los éteres de oxima se obtuvieron mediante alquilación de oximas con bromuro de propargilo o bromuro de 2-bromobencilo, empleando como base NaOH y acetona como solvente. Los isoxazoles se obtuvieron mediante cicloadiciones 1,3-dipolares empleando nitrato cérico amónico (NAC), cloramina-T (CAT) y NaOCl. Los productos fueron identificados y/o caracterizados por resonancia magnética nuclear (RMN) y espectrometría de masas (EM). Se realizaron pruebas de inhibición de crecimiento radial sobre Aspergillus niger y Fusarium roseum. Resultados. Se obtuvieron cinco oximas, siete éteres de oxima, cuatro de ellos nuevos y cuatro nuevos isoxazoles. Las sustancias evaluadas presentaron actividad antifúngica a cantidades de 1,5 mg y 3,0 mg. Conclusiones. Aunque las cicloadiciones 1,3-dipolares permitieron obtener los isoxazoles esperados, se observó que ésta metodología generó una amplia variedad de subproductos lo que disminuyó los rendimientos e hizo difícil la purificación del producto de interés. Cuatro de las sustancias evaluadas presentaron porcentajes de inhibición superiores al 80%...


Synthesis and in vitro assessment of antifungal activity of oximes, oxime ethers and isoxazoles. Objective. To synthesize and carry out a preliminary evaluation of the in vitro antifungal activity of oximes, oxime ethers and isoxazoles. Materials and methods. Oximes were synthesized from aldehydes or ketones with NH2OH.HCl and K2CO3. Oxime ethers were prepared by alkylation of oximes with propargyl bromide or 2-bromobenzyl bromide, using NaOH as base and acetone as solvent. The isoxazoles were obtained by 1,3-dipolar cycloadditions using ceric ammonium nitrate (CAN), chloramine T (CAT) and NaOCl. Products were identified or characterized using nuclear magnetic resonance (NMR) and mass spectrometry (MS). Radial growth inhibition assays against Aspergillus niger and Fusarium roseum were carried out. Results. Five oximes, seven oxime ethers, four of them new, and four new isoxazoles were obtained. The assessed substances exhibited antifungal activity in amounts of 1,5 mg and 3,0 mg. Conclusions. Although 1,3-dipolar cycloadditions allowed to obtain the desired isoxazoles, this methodology produced a wide variety of side products that reduced yields and made difficult the purification of the target products. Four of the tested compounds showed inhibition percentages greater than 80%...


Síntese e avaliação “in vitro” da atividade antifúngica de oximas, éteres de oxima e isoxazóis. Objetivo. Sintetizar e realizar a avaliação preliminar da atividade antifúngica in vitro de oximas, éteres de oxima e isoxazóis. Materiais e métodos. As oximas foram sintetizadas a partir de aldeídos ou cetonas com NH2OH.HCl e K2CO3. Os éteres de oxima foram obtidos pela alquilação de oximas com brometo de propargilo ou brometo de 2-bromobenzilo, utilizando NaOH como base e acetona como solvente. Os isoxazóis foram obtidos por cicloadição 1,3-dipolar usando nitrato cérico de amônio (NCA), cloramina-T (CAT) e NaOCl. Os produtos foram identificados e / ou caracterizados por ressonância magnética nuclear (RMN) e espectrometria de massas (EM). Foram realizados testes de inibição sobre o crescimento radial de Aspergillus niger e Fusarium roseum. Resultados. Foram obtidas cinco oximas, sete éteres de oxima, quatro deles novos e quatro novos isoxazóis. As substâncias testadas apresentaram atividade antifúngica em quantidades de 1,5 mg e 3,0 mg. Conclusões. Embora as cicloadições 1,3-dipolares permitiram obter os isoxazóis esperados, observou-se que esta metodologia resultou numa grande variedade de subprodutos que reduziram os rendimentos e tornaram difícil a purificação do produto de interesse. Quatro das substâncias testadas apresentaram porcentagens de inibição acima de 80%...


Subject(s)
Antifungal Agents/analysis , Antifungal Agents/adverse effects , Ethers , Oximes
17.
Rev. méd. Chile ; 139(9): 1128-1134, set. 2011. tab
Article in Spanish | LILACS | ID: lil-612235

ABSTRACT

Background: Systemic fungal infections and specifically invasive aspergillosis (IA) are associated with a high morbi-mortality rate in patients with hematologic malignancies. Itraconazole kinetic studies show that plasma levels are not satisfactory, even though there is a reduction of the severity in clinical cases. Aim: To evaluate the results of oral prophylaxis with high dose itraconazole, 400 mg bid, among patients with adult acute leukemia. Material and Methods: Prospective analysis of 93 high risk febrile episodes (with an absolute neutrophil count of less than 500 x mm3 for more 10 days), that occurred in 76 patients. Results: Seventy five percent of episodes occurred in patients with acute myeloid leukemia and 25 percent in patients with acute lymphoblastic leukemia. Fifty two percent occurred during the induction of chemotherapy. Median duration of severe neutropenia was 21 days (range 10-48). Median duration of itraconazole prophylaxis was 17 days (range 6-34). A low frequency of invasive fungal infections was observed (17 percent). According to diagnostic criteria, 5 percent of episodes corresponded to persistent fever , 1 percent and 11 percent of episodes, to probable or possible IA, respectively. No confirmed or proven IA was observed. Mortality of IA was 18 percent. No serious adverse events due to itraconazole were observed. Conclusions: The use of high dose itraconazole prophylaxis in adult patients with acute leukemia and severe neutropenia was associated to low incidence and mortality of invasive mycoses.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Antifungal Agents/administration & dosage , Itraconazole/administration & dosage , Leukemia, Myeloid, Acute/drug therapy , Mycoses/prevention & control , Neutropenia/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Acute Disease , Administration, Oral , Antifungal Agents/adverse effects , Aspergillosis/prevention & control , Fever/drug therapy , Itraconazole/adverse effects , Neutropenia/chemically induced , Prospective Studies , Pulmonary Aspergillosis/prevention & control
18.
Yonsei Medical Journal ; : 863-865, 2011.
Article in English | WPRIM | ID: wpr-182764

ABSTRACT

This is a case report on a 35-year-old man with acute myelogenous leukemia who presented fever and intermittent mucoid loose stool to the emergency center. He had been taking voriconazole for invasive pulmonary aspergillosis. The flexible sigmoidoscopy was consistent with the diagnosis of pseudomembranous colitis.


Subject(s)
Adult , Antifungal Agents/adverse effects , Enterocolitis, Pseudomembranous/chemically induced , Humans , Invasive Pulmonary Aspergillosis/complications , Leukemia, Myeloid, Acute/complications , Male , Opportunistic Infections/complications , Pyrimidines/adverse effects , Triazoles/adverse effects
19.
Rev. chil. infectol ; 27(1): 25-33, feb. 2010. tab
Article in Spanish | LILACS | ID: lil-537163

ABSTRACT

Amphotericin B deoxycholate is associated with infusion-related toxicity and renal toxicity. Purpose: To evaluate medical indications of this compound in a tertiary care center, analyze adverse reactions, infusion protocols and outcome of treated patients. Patients and methods: Retrospective analysis of 39 treatments indicated in 33 patients during 2007, exploring indications, infusion protocols and renal protective measures, infusion-related adverse reactions, nephrotoxicity, hypokalemia and outcomes. Results: On average, therapy lasted 12 days (2 to 39) and reached 600 mg of accumulated dose (100 to 1950) respectively. 24-hours infusions were applied in 63.2 percent of prescriptions and 35.9 percent received a 4-6 hour infusion schedule. In addition, 36.8 percent received daily a saline infusion before amphotericin. Adverse reactions were observed in 40 percent of treatments, predominating fever (25 percent). Nonetheless, nephrotoxicity was infrequent (9.4 percent), of low magnitude, only affecting patients without previous renal disease, and not requiring dialysis. Hypokalemia developed in 21.6 percent of treatments. More than half of medical indications were empirical (59 percent), for presumed infections by either filamentous fungi or yeasts. In the subgroup with microbiological information, main indications were invasive aspergillosis (15.4 percent of total), systemic candidiasis (12.8 percent) or meningeal cryptococcosis (10.3 percent). A favorable response was registered in 41 percent, and only 48.5 percent of patients survived. In a multivariate analysis, only age > 60 years remained as an independent factor for developing infusion-related adverse reactions. In the same manner, a SOFA score > 3 and corticosteroids administration at the same time than amphotericin B, were independently associated to a fatal outcome. Conclusion: infusion-related adverse reactions are frequent during amphotericin B deoxycholate therapy, but renal...


Anfotericina B deoxicolato se asocia a reacciones adversas durante la infusión y a nefrotoxicidad. Objetivo: Evaluar las indicaciones de anfotericina B deoxicolato en un hospital universitario, las reacciones adversas asociadas, los protocolos de administración y el desenlace de los pacientes tratados. Pacientes y Métodos: Se efectuó un estudio retrospectivo con el total de tratamientos efectuados durante el año 2007 en el Hospital Clínico de la Universidad de Chile, identificando 39 tratamientos en 33 pacientes. Se analizaron las indicaciones, dosis, protocolos de administración, efectos adversos relacionados a la infusión (fiebre, calofríos, vómitos o flebitis), nefrotoxicidad, hipokalemia y además la evolución de los pacientes. Resultados: La duración promedio del tratamiento fue de 12 días (2-39) con una dosis acumulada promedio de 600 mg totales (100-1.950 mg). Un 63,2 por ciento de los tratados recibió infusiones de 24 horas y 35,9 por ciento, infusiones de 4 a 6 horas. Además, 36,8 por ciento fue sometido a precargas salinas. Un 40 por cientoo de los tratamientos se acompañó de reacciones adversas asociadas a la infusión, predominando la fiebre (25 por ciento). Sin embargo, la nefrotoxicidad fue de baja magnitud (9,4 por cientoo), sólo presente en pacientes sin falla renal previa y en ningún caso determinó el inicio de diálisis. La hipokalemia se presentó en ocho tratamientos (21,6 por ciento). Más de la mitad de las indicaciones fueron empíricas (59 por cientoo), ya fuese para el tratamiento presunto de hongos filamentosos (aspergilosis o mucormicosis) o levaduras (candidiasis sistémica). En el subgrupo con datos micro-biológicos, las principales indicaciones fueron aspergilosis invasora (15,4 por ciento de los 39 tratamientos), candidiasis sistémica (12,8 por ciento) o criptococosis meníngea (10,3 por ciento). Un 41 por cientoo de los pacientes tuvo una respuesta favorable a los tratamientos y sólo 48,5 por cientoo sobrevivió...


Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Amphotericin B/adverse effects , Antifungal Agents/adverse effects , Deoxycholic Acid/adverse effects , Mycoses/drug therapy , Amphotericin B/administration & dosage , Antifungal Agents/administration & dosage , Chile , Drug Combinations , Deoxycholic Acid/administration & dosage , Hospitals, University , Kidney Diseases/chemically induced , Mycoses/classification , Retrospective Studies , Time Factors , Young Adult
20.
Rev. AMRIGS ; 53(3): 241-245, jul.-set. 2009. tab
Article in Portuguese | LILACS | ID: lil-566956

ABSTRACT

Introdução: A candidíase constitui uma das infecções oportunistas mais frequentes em pacientes oncológicos, sendo resultado do desequilíbrio da ecologia do ambiente, em virtude dos tratamentos antineoplásicos. Objetivo: Investigar através de uma revisão sistemática as intervenções para o tratamento de candidíase orofaríngea em pacientes com câncer de cabeça e pescoço. Metodologia: Consulta em bases de dados eletrônicos MEDLINE, LILACS e BBO, cuja coleta de dados incluiu estudos de intervenção (ensaio clínico), apresentando desfechos relacionados à avaliação clínica e microbiológica da candidíase através dos antifúngicos. As estratégias de buscas utilizadas incluíram como palavras: cancer and (oral or bucal or neck or head) and (treatment or therapy), nos idiomas português, inglês e espanhol, no período de 1966 a 2007. Resultados: Foram selecionados três estudos, todos no idioma inglês, sendo que apenas um objetivou avaliar a resposta dos indivíduos ao fluconazol e os demais compararam a resposta do fluconazol a outras drogas (voriconazol, itraconazol e anfotericina B). Conclusão: O fluconazol apresentou melhores resultados, sendo eficaz em debelar a candidíase orofaríngea. No entanto, deve-se atentar para a resistência de determinadas linhagens de cândida ao fluconazol, devendo o profissional ser capaz de escolher o medicamento de melhor efeito para cada caso.


Introduction: Candidiasis (thrush) is one of the most common opportunistic infections among cancer patients, being a result of an imbalance in the environmental ecology because of the antineoplastic therapies. Aim: To investigate through a systematic review the available interventions for treatment of oral candidiasis in patients with head and neck cancer. Methods: A review was made of electronic databases MEDLINE, LILACS and BBO, in which data collection included intervention studies (clinical trials) presenting outcomes related to clinical and microbiological evaluation of candidiasis through antifungal drugs. The search strategies included words like cancer and (oral or buccal or neck or head) and (treatment or therapy), in Portuguese, English and Spanish, from 1966 to 2007. Results: Three studies were selected, all written in English, one of which evaluating patient response to fluconazole and the other two comparing response to fluconazole with other drugs (voriconazole, itraconazole and amphotericin B). Conclusion: Fluconazole presented the best results, being effective to suppress oral candidiasis. However, the resistance of certain candida strains to fluconazole must be considered, so as to be able to select the drug that is most likely to succeed in each particular case.


Subject(s)
Humans , Candidiasis, Oral/complications , Candidiasis, Oral/diagnosis , Candidiasis, Oral/epidemiology , Candidiasis, Oral/pathology , Candidiasis, Oral/prevention & control , Meta-Analysis as Topic , Head and Neck Neoplasms/complications , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/epidemiology , Antifungal Agents/adverse effects , Antifungal Agents/therapeutic use , Fluconazole , Itraconazole
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