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Title Treating Oral Candidiasis with oral antifungal agents
Clinical Question In an adult immunocompromised (HIV) patient with Oral Candidiasis, is fluconazole a more effective treatment than other oral antifungal agents?
Clinical Bottom Line Fluconazole and itraconazole are the best treatment for Oral Candidiasis in an immunocompromised patient compared to ketoconazole, nystatin, clotrimazole, and amphotericin B. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16856025 Pienaar/2006HIV positive adults/children with OCSystematic Review
Key resultsWhen comparing treatment to nystatin, fluconazole favored clinical cure in adults. There was no difference regarding clinical cure between fluconazole to ketoconazole, itraconazole, clotrimazole. When compared with Clotrimazole, both fluconazole and itraconazole proved to be better for mycological cure.
#2) 11505264Patton/2001HIV positive patients(adults, children, infants) with OCMeta Analysis/Systematic Review
Key results“Fluconazole appears to be from 87% to 100% effective in obtaining a complete clinical response after 14 days of therapy and from 53% to 87% effective in obtaining a culture negative for Candida species. Fourteen-day therapy with itraconazole (71%-97% clinical response rates) appears to be roughly equivalent to fluconazole, with ketoconazole (43%-81% clinical response rates) achieving the same or slightly lower response rates. Fluconazole and itraconazole appear to be more effective with respect to the management of oropharyngeal candidiasis than nystatin (9%-52% clinical response rates) or clotrimazole (65%-85% clinical response rates), particularly when taking mycologic response rates and relapse rates into account.” (Pattton, LL )
Evidence Search Meta-Analysis, Randomized Controlled Trial "Antifungal Agents"[Mesh],Search "Candidiasis, Oral"[Mesh]
Comments on
The Evidence
The study design is a meta-analysis and a systematic review, which illustrates the highest level of evidence. Patient group was similar at start, groups were treated the same, there was adequate follow up, and compliance was adequate. Therefore, the articles searched are valid and provided answers for the clinical question.
Applicability Subjects are representative of my patients and treatment is feasible in my settings.
Specialty/Discipline (General Dentistry)
ID# 543
Date of submission: 03/29/2010spacer
E-mail nguyenql@livemail.uthscsa.edu
Author Quyen Nguyen
Co-author(s) e-mail
Faculty mentor/Co-author Erica Oliveira, DDS, MPH
Faculty mentor/Co-author e-mail OLIVEIRAE@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
post a comment
by Danielle Larivey (San Antonio, TX) on 04/20/2012
I conducted a PubMed search on this topic in April 2012 and found a more recent publication: PubMed ID 20597560. This publication demonstrated resistance to fluconazole and itraconazole in HIV/AIDS patients, and suggests that further investigation into anti-fungal resistance in treating Candida species in AIDS patients should be performed.

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