       Document 0271
 DOCN  M9640271
 TI    Fluconazole. An update of its pharmacodynamic and pharmacokinetic
       properties and therapeutic use in major superficial and systemic mycoses
       in immunocompromised patients.
 DT    9604
 AU    Goa KL; Barradell LB; Adis International Limited, Auckland, New Zealand.
 SO    Drugs. 1995 Oct;50(4):658-90. Unique Identifier : AIDSLINE MED/96106621
 AB    Fluconazole is a triazole antifungal agent which is now an established
       part of therapy in patients with immune deficiencies. It is effective
       against oropharyngeal/oesophageal candidiasis (candidosis) when used
       orally once daily either as treatment or secondary prophylaxis in
       patients with AIDS or as treatment or primary prophylaxis in neutropenia
       associated with cancer therapy. Fluconazole also resolves symptoms in up
       to 60% of patients with cryptococcal meningitis and AIDS. However, in
       this infection its efficacy as treatment relative to that of
       amphotericin B is equivocal, and its major role is as the drug of choice
       for maintenance therapy following amphotericin B induction. In this
       regard, fluconazole has been proven superior to amphotericin B and to
       itraconazole 200 mg/day. Comparisons with other drugs used for the
       treatment of mucosal candidiasis in patients with AIDS show fluconazole
       to be superior to nystatin, similar to itraconazole and at least as
       effective as clotrimazole and ketoconazole; it was more so than the
       latter azole in 1 study. In patients undergoing chemotherapy or bone
       marrow transplantation, fluconazole as primary prophylaxis has produced
       greater clinical benefit than a clotrimazole regimen. The incidence of
       adverse events appears to be somewhat higher in patients with AIDS
       compared with HIV-negative cohorts, but the qualitative pattern of
       events is similar. The most frequent events are gastrointestinal
       complaints, headache and skin rash: rare exfoliative skin reactions and
       isolated instances of clinically overt hepatic dysfunction have occurred
       in patients with AIDS. Issues yet to be clarified include: the use of
       fluconazole in children with AIDS, in whom results have been promising;
       its efficacy against other fungal infections encountered in
       immunocompromised patients; whether the drug influences mortality, as
       has been suggested by one placebo-controlled trial in patients
       undergoing bone marrow transplant; and the appropriateness of its
       potential for use as primary prophylaxis against cryptococcal meningitis
       in patients with AIDS, where it shows efficacy but there is concern over
       increasing risk of development of secondary resistance. Notwithstanding
       these undefined aspects of its clinical profile, fluconazole is now
       confirmed as an important antifungal drug in the management of fungal
       infections in patients with immune deficiencies. In patients with AIDS
       it is the present drug of choice as maintenance therapy against
       cryptococcal meningitis and is a preferred agent for secondary
       prophylaxis against candidal infections; it is also a favoured agent for
       primary prophylaxis in patients at risk because of neutropenia
       associated with chemotherapy or bone marrow transplantation .
 DE    Acquired Immunodeficiency Syndrome/IMMUNOLOGY/MICROBIOLOGY  Animal
       Antifungal Agents/*PHARMACOLOGY/*PHARMACOKINETICS  AIDS-Related
       Opportunistic Infections/IMMUNOLOGY/MICROBIOLOGY  Child  Comparative
       Study  Fluconazole/*PHARMACOLOGY/*PHARMACOKINETICS  Human  HIV
       Infections/IMMUNOLOGY/MICROBIOLOGY  *Immunocompromised Host
       Mycoses/*DRUG THERAPY/*IMMUNOLOGY/METABOLISM
       Neoplasms/IMMUNOLOGY/MICROBIOLOGY  JOURNAL ARTICLE  REVIEW  REVIEW,
       TUTORIAL

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

