Efficacy of oral fluconazole in the treatment of AIDS associated oesophageal candidiasis.

To assess the efficacy and tolerance of fluconazole in the treatment of oesophageal candidiasis, 47 AIDS patients with this infection were enrolled in an open prospective study using fluconazole 100 mg given orally once daily. Clinical cure was obtained in all of 41 evaluable patients, with confirmation of cure in all of 31 patients who underwent post-treatment oesophagoscopy. Forty patients were followed up for at least 30 days; none suffered a relapse of oesophagitis but seven had a recurrence of stomatitis which was effectively treated with fluconazole. Fluconazole was well tolerated. Nausea was noted in three patients one of whom interrupted therapy. Transient mild elevation of ALT/AST was noted in five of 41 patients (12%). Fluconazole appears to be a safe and effective agent for oral therapy of oesophageal candidiasis associated with AIDS.

Comparison of fluconazole and ketoconazole for oropharyngeal candidiasis in AIDS.

In a randomised, double-blind study the efficacy and toxicity of oral fluconazole 50 mg daily and ketoconazole 200 mg daily were compared for the treatment of oropharyngeal candidiasis in patients with acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC). 20 episodes (18 patients) were treated with fluconazole and 20 episodes (19 patients) with ketoconazole. Pretreatment clinical features and laboratory test results were similar in both groups. 17 episodes (85%) in the fluconazole group and 16 (80%) in the ketoconazole group could be evaluated. There was clinical cure at the end of therapy in all fluconazole-treated and 12 of 16 (75%) ketoconazole-treated episodes. Cultures were negative at the end of therapy in 87% of the fluconazole group and 69% of the ketoconazole group. 1 patients stopped taking fluconazole because of severe nausea. 1 of 18 fluconazole-treated and 4 of 19 ketoconazole-treated patients had transient rises in alanine or aspartate aminotransferase. Fluconazole seemed more effective than ketoconazole in the treatment of oral thrush among AIDS and ARC patients.

Single-drug versus combination empirical therapy for gram-negative bacillary infections in febrile cancer patients with and without granulocytopenia.

Empirical therapy with cefoperazone was compared with cefoperazone plus amikacin in granulocytopenic and nongranulocytopenic febrile patients. In nonneutropenic patients the overall response rate to cefoperazone was 88%; 10 of 12 gram-negative bacteremic patients were cured. Cefoperazone plus amikacin resulted in an 88% overall response rate and cured 14 of 15 patients with bacteremia. In neutropenic patients the overall response rate was 77% with cefoperazone alone and 73% with cefoperazone plus amikacin; the cure rates for gram-negative bacteremias were 8 of 11 and 6 of 12 patients, respectively. Our findings support the concept of single-drug empirical therapy with cefoperazone in febrile cancer patients, whether granulocytopenic or not, especially when gram-negative bacteremias are predominantly caused by Escherichia coli or Klebsiella species. The issue of Pseudomonas spp. and other more resistant pathogens needs further assessment with a larger number of patients.

Causes of death in febrile granulocytopenic cancer patients receiving empiric antibiotic therapy.

We reviewed the causes of death of 55 granulocytopenic patients who received empiric antibiotic treatment for fever according to an EORTC cooperative protocol; 53 presented cancer and 2 aplastic anemia. Among the 55 patients, 19 (35%) deaths were attributed to infection: 16 to bacterial and 3 to fungal infections. Among the patients with bacterial infections, 12 died from septic shock, 3 from pneumonia and 1 from Pseudomonas aeruginosa meningitis. The most frequent non-infectious causes of death were the cancer progression (18%) and hemorrhagic complications (27%), most often cerebromeningeal in relationship to thrombocytopenia. A large number of the patients who died from infection (78%) and hemorrhage (74%) had advanced cancer with poor chances to respond to anticancer therapy.

Combination chemotherapy with cisplatin, etoposide, and vindesine in non-small cell lung carcinoma: a clinical trial of the EORTC lung cancer working party.

A combination of cisplatin (60 mg/m2 on Day 1), etoposide (120 mg/m2 on Days 3, 5, and 7), and vindesine (1.5 mg/m2 on Days 1 and 7), repeated every 3 weeks, was administered to 73 patients with non-small cell bronchogenic carcinoma. After two full courses, the results could be evaluated in 62 patients, 25 (40.3%) of whom responded (five complete responses, 20 partial responses). The median survival for the responding patients (12 months) was significantly superior (P = 0.02) to that of the nonresponding patients. There were three early toxic deaths from sepsis associated with granulocytopenia, and seven patients presented peripheral neuropathy. Although active in non-small cell bronchogenic carcinoma, the combination of cisplatin, etoposide, and vindesine does not appear to be superior to cisplatin-etoposide or cisplatin-vindesine when our previous experience and the results reported from other institutions are considered.