amphotericin-b and Esophagitis

Dysphagia following cardiac surgery is a frequently encountered problem, being most commonly due to the sternotomy incision and/or prolonged intubation. Oesophageal candidiasis is an increasing problem that is usually associated with immunosuppression or immunodeficiency. We report a 59 years age, immunocompetent lady whom had developed dysphagia and odynophagia following open cardiac surgery and long term course of antibiotics. Diagnosis of Candida oesophagitis was established after radiological, endoscopic and microbiological evidence, and successful treatment with combined topical and systemic antifungal therapy was achieved. Possibility of immunodeficiency was excluded. We believe that this lady developed oesophageal candidiasis due to a long-term course of broad spectrum antibiotics. We discuss the various diagnostic modalities and treatment options.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Candidiasis, Oral; Deglutition Disorders; Dilatation; Drug Therapy, Combination; Esophagitis; Female; Humans; Immunocompetence; Middle Aged; Nystatin; Thoracic Surgery; Treatment Outcome

The high frequency of oropharyngeal candidiasis in immunocompromised patients has led many institutions to develop protocols to guide the use of antifungal agents in the treatment of this opportunistic infection. However, few specific recommendations have been made for directing the management of oropharyngeal candidiasis in patients infected with HIV. To meet this need, a panel of experts representing a variety of disciplines met to formulate a consensus and devise a treatment strategy for clinical application. Among other recommendations, the algorithm calls for use of a topical agent for the treatment of initial and recurring oropharyngeal candidiasis in HIV-infected patients, provided there is no esophageal involvement, patients' CD4+ lymphocyte cell count is >50 cells/mm3, and they are currently receiving or expected to receive effective antiretroviral treatment. For episodes of oropharyngeal candidiasis with concurrent esophageal involvement or where patients have a CD4+ cell count of <50 cells/mm3, are not receiving or anticipating highly active antiretroviral therapy (HAART), and have a high viral load, the algorithm suggests a systemic oral azole as the more appropriate treatment choice. Acute treatment of all oropharyngeal candidiasis episodes is preferred. Chronic suppressive antifungal treatment is to be avoided in recognition of the potential for the development of drug-resistant infection.

Topics: Acquired Immunodeficiency Syndrome; Administration, Oral; AIDS-Related Opportunistic Infections; Algorithms; Amphotericin B; Anti-HIV Agents; Antifungal Agents; Candidiasis; Candidiasis, Oral; Clotrimazole; Dosage Forms; Esophagitis; Humans; Imidazoles; Viral Load

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Esophagitis; Humans; Nystatin

Esophagitis is an important side effect in thoracic radiotherapy, no preventive drug therapy has been established yet. The aim of the present study was to prospectively evaluate the effectiveness of prophylactic antimycotic treatment with amphotericin B lozengers.. 40 consecutive patients with high-dose thoracic radiotherapy for lung cancer were investigated in a nonrandomized study. 20 patients receiving a median maximal esophageal dose of 67 Gy (range 61-80 Gy) were treated with amphotericin B lozengers four times daily from day 8 to the end of radiotherapy. Another 20 patients with a lower median maximal esophageal dose of 60 Gy (range 51-67.5 Gy) constituted the control group. Length of the irradiated esophagus and dose-length indices were evaluated. Side effects were prospectively scored according to the RTOG/EORTC criteria. There was a trend toward higher esophageal volumes in the prophylaxis group; furthermore, patients in this group were older, had a worse median Karnofsky Index and had more often received induction chemotherapy.. In the prophylaxis group, 15 patients remained free from esophagitis and five patients developed esophagitis grade 1. In the control group, four patients remained free from symptoms, 14 patients showed esophagitis grade 1 and two patients grade 2. The difference between the two groups was statistically significant (p < 0.05). The start of symptoms was delayed in the prophylaxis group in comparison to the control group: day 21 (median, range 14-44) and day 18 (median, range 10-32) respectively. Amphotericin B lozengers were tolerated without side effects by all patients.. Prophylactic administration of amphotericin B lozengers seems to effectively prevent radiation-induced esophagitis.

Topics: Administration, Oral; Adult; Aged; Amphotericin B; Antifungal Agents; Candidiasis; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Esophagitis; Esophagus; Female; Follow-Up Studies; Humans; Lung Neoplasms; Male; Middle Aged; Prospective Studies; Radiation Injuries; Radiotherapy, High-Energy

To investigate whether cytochrome P450-dependent enzymes are influenced by amphotericin B (Am-B) during the treatment of Candida oesophagitis in HIV-infected patients.. Twelve HIV-infected, antiretroviral-naive patients (CDC/WHO stage C3) with Candida oesophagitits were enrolled into a prospective clinical trial. The patients were treated with Am-B (0.4 mg/kg body weight) for two weeks. At baseline and after Am-B therapy the clearance of antipyrine and its metabolites were investigated by high-performance liquid chromatography. In addition, the urinary excretion of 6-beta-hydroxycortisol and 17-hydroxycorticosteroids was assessed by means of a radioimmunoassay.. The following significant changes were observed after Am-B treatment (P < 0.01): increase of antipyrine half-life (12.4 h vs 16.8 h) and the area under the plasma concentration-time curve (27.9 mg min/ml vs 38.1 mg min/ml); decrease of the total body clearance (61.2 ml/min vs 43.7 ml/min); decrease of the renal clearance of antipyrine metabolites - norantipyrine (7.45 ml/min vs 5.31 ml/min), 4-hydroxyantipyrine (15.4 ml/min vs 10.3 ml/min), hydroxymethylantipyrine (4.31 ml/min vs 3.65 ml/min); decrease of urinary 6-beta-hydroxycortisol excretion (453 microg/24h vs 298 microg/24h) and the ratio of 6-beta-hydroycortisol to 17-hydroxycorticosteroids (8.8% vs 6.4%).. Our data indicate that Am-B therapy has an inhibitory effect on cytochrome P450-dependent enzymes in HIV-infected patients. These results are of particular significance for HIV-infected patients who are concomitantly treated with drugs that are predominantly metabolised in the liver. A careful drug monitoring system seems advisable, especially for proteinase inhibitor experienced HIV-1-infected subjects.

Topics: 17-Hydroxycorticosteroids; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Bacterial Agents; Antipyrine; Candidiasis; Chromatography, High Pressure Liquid; Cytochrome P-450 Enzyme System; Esophagitis; Humans; Hydrocortisone; Immunocompromised Host

Caspofungin is a new broad-spectrum antifungal drug. A multicenter, double-blind, randomized trial was conducted to assess the efficacy, safety, and tolerability of caspofungin relative to amphotericin B in adults with endoscopically documented symptomatic Candida esophagitis. By use of a modified intent-to-treat analysis, endoscopically verified clinical success was achieved in 74% (95% confidence interval [CI], 59%-86%) and 89% (95% CI, 72%-98%) of patients receiving caspofungin at 50 and 70 mg/day, respectively, and in 63% (95% CI, 49%-76%) of patients given amphotericin B at 0.5 mg/kg/day. Therapy was stopped because of drug-related adverse events in 24% of patients in the amphotericin B group and 4% and 7%, respectively, for the caspofungin groups. This report provides the first demonstration of clinical utility for an echinocandin compound. Caspofungin appeared in this study to be as effective as and better tolerated than amphotericin B for the treatment of esophageal candidiasis.

Topics: Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Candidiasis; Caspofungin; Consumer Product Safety; Double-Blind Method; Drug Tolerance; Echinocandins; Esophagitis; Esophagoscopy; Female; Humans; Lipopeptides; Male; Middle Aged; Peptides; Peptides, Cyclic

Invasive candidiasis infections remain a major complication in I.C.U. patients. Numerous attempts have been made to evaluate potential prophylactic methods. Various agents have been tested. Gastrointestinal tract constitutes one of the major reservoirs for Candida species. One major problem is the difficulty in establishing an accurate, early, diagnosis of invasive fungal infection. A prospective randomized, controlled blind study was performed to assess the ability of oral Amphotericin B to prevent candidiasis in selected I.C.U. patients. Fifty one patients with serious infection and antibiotherapy were randomized to receive either oral Amphotericin B (2 g/day) or placebo, and observed until discharge. All patients were screened weekly for sites culture positive, sero-conversion and oesophagitis. Invasive candidiasis developed in 45% of patients receiving Amphotericin B compared with 41% receiving placebo. C. Albicans persists in the surveillance cultures. However a significant reduction of the colonization by the yeasts and a significant reduction of oesophagitis was demonstrated among the Amphotericin B group. No benefit was found in the total number of hospital days. Digestive decontamination can be successfully managed by Amphotericin B in I.C.U. patients but failed to prevent invasive candidiasis.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Candidiasis; Clinical Protocols; Cross Infection; Digestive System; Esophagitis; Female; Humans; Intensive Care Units; Male; Middle Aged; Randomized Controlled Trials as Topic; Risk Factors

The effectiveness of treatment of candidiasis of the esophagus by different methods and preparations (nystatin, amphotericin B, donor leukocytic mass) was compared in 34 patients. Local application of amphotericin B and donor leukocytic mass was found the most effective in the combined treatment of candidiasis of the esophagus.

Topics: Adult; Amphotericin B; Blood Transfusion; Candidiasis; Clinical Trials as Topic; Esophagitis; Female; Humans; Leukocyte Transfusion; Male; Middle Aged; Nystatin

Of 224 consecutive renal transplant patients in a prospective, randomized immunosuppressive trial, candida esophagitis developed in 5 despite nystatin prophylaxis. No differences were noted between cyclosporine and antilymphocyte globulin-azathioprine immunosuppressive treatment. All patients were diabetic, and four were recipients of cadaver kidneys. Candida esophagitis occurred within 6 months after transplantation, and only one patient had recurrence. All patients responded to treatment consisting of 2 to 6 days of intravenous amphotericin B (0.2 to 2 mg/kg total dose). The prevalence of candida esophagitis was not related to rejection episodes. Three of five patients eventually died, one 2 weeks after resolution of candida esophagitis from a hypoglycemic episode, one from acute exacerbation of pulmonary failure and relapsing pancreatitis in association with candida esophagitis and therapy-resistant candidemia, and one 17 months after candida esophagitis from pulmonary edema. Our findings show that candida esophagitis by itself is an easily managed complication, but is also a sign of potentially increased morbidity in these patients.

Topics: Adult; Amphotericin B; Antilymphocyte Serum; Azathioprine; Candidiasis; Clinical Trials as Topic; Cyclosporins; Esophagitis; Female; Humans; Kidney Transplantation; Male; Minnesota; Nystatin; Prospective Studies; Random Allocation

We present the case of a 74-y-old HIV-negative female who suffered simultaneously from multiple opportunistic infections and a Klebsiella pneumoniae sepsis during high-dose steroids for giant cell arteritis. The patient was treated with a purine analog due to hairy cell leukaemia 10 y previously. Purine analog therapy can lead to long lasting defects in cell-mediated immunity. In these patients, treatment with steroids should be closely monitored with CD4 counts.

Topics: Aged; Amphotericin B; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antifungal Agents; Antineoplastic Agents; Aspergillosis; Cladribine; Cytomegalovirus; Dexamethasone; Esophagitis; Female; Giant Cell Arteritis; Herpes Simplex; Humans; Klebsiella Infections; Klebsiella pneumoniae; Leukemia, Hairy Cell; Methylprednisolone; Opportunistic Infections; Pneumocystis carinii; Trimethoprim, Sulfamethoxazole Drug Combination

After 10 days of minocycline therapy, stomatitis, glossitis and esophagitis were seen in a 62-year-old male patient, who had previously tolerated minocycline for > 20 years without complications. This typical side effect of minocycline was initially misinterpreted in the differential diagnosis and was only diagnosed, when the patient was reexposed to a new 7-day minocycline therapy. Healing was achieved by termination of the minocycline therapy and the initiation of antimycotic treatment.

Topics: Acne Vulgaris; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Esophagitis; Glossitis; Humans; Male; Middle Aged; Minocycline; Stomatitis; Time Factors

To report a case of successful treatment of azole-refractory oropharyngeal candidiasis with topical amphotericin B.. A 30-year-old white woman presented with recurrent oral thrush. The patient had been exposed to azole antifungals for >20 years, and in vitro susceptibility tests revealed class resistance. The patient started taking amphotericin B 100 mg oral suspension swish-and-spit 4 times daily. After 4 weeks of topical amphotericin B treatment, the patient reported significant symptomatic improvement. The oral candidiasis worsened following a course of oral antibiotics, but improved once the antibiotic was discontinued and after receiving amphotericin B swish-and-swallow for 4 additional weeks.. Current Infectious Diseases Society of America guidelines include topical amphotericin B as a potentially effective option for the treatment of oropharyngeal candidiasis. There is limited evidence to support this recommendation. Besides lack of data, an appropriate dosing regimen and consistent means of product formulation need to be determined.. This report demonstrates the potential role for topical amphotericin B in the treatment of azole-refractory oral candidiasis. Double-blind, randomized, controlled trials are needed to define dosing, efficacy, administration, and long-term safety of oral amphotericin B.

Topics: Administration, Topical; Adult; Amphotericin B; Antifungal Agents; Azoles; Candidiasis, Oral; Drug Resistance, Fungal; Esophagitis; Female; Humans

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Candida albicans; Candidiasis; Caspofungin; Echinocandins; Esophagitis; Humans; Lipopeptides; Peptides; Peptides, Cyclic

Topics: Amoxicillin; Amphotericin B; Antifungal Agents; Biopsy; Candidiasis; Deglutition Disorders; Esophagitis; Esophagoscopy; Humans; Male; Middle Aged; Penicillins; Predictive Value of Tests; Radiography

Topics: AIDS-Related Opportunistic Infections; Ambulatory Care; Amphotericin B; Antifungal Agents; Candidiasis, Oral; Esophagitis; Fluconazole; Guidelines as Topic; Humans; Itraconazole; Ketoconazole; Medical Audit; Nystatin; Retrospective Studies

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Drug Resistance, Microbial; Drug Resistance, Multiple; Esophagitis; Fluconazole; Humans; Male; Microbial Sensitivity Tests

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Child; Endoscopy, Digestive System; Esophagitis; Esophagus; Fluconazole; Humans; Male; Mouth

We performed antifungal susceptibility tests with cilofungin (LY121019), amphotericin B, and flucytosine against 38 strains of yeasts from patients with esophagitis or fungemia either before, during, or after treatment with cilofungin. Tests were performed using a macrobroth dilution method similar to that proposed by the National Committee for Clinical Laboratory Standards (M27-P) and two microbroth methods. For cilofungin and amphotericin B, minimum inhibitory concentrations from microbroth tests using Antibiotic Medium 3 (AM3) were systematically lower than results from the other two methods that utilized RPMI-1640 medium (RPMI). AM3 did not provide any greater degree of in vitro correlation with clinical results than did RPMI. We conclude that cilofungin and possibly other congeners of the echinocandin class of antifungal agents can effectively be studied using the proposed National Committee for Clinical Laboratory Standards method.

Topics: Amphotericin B; Candida; Candidiasis; Drug Resistance, Microbial; Echinocandins; Esophagitis; Evaluation Studies as Topic; Flucytosine; Fungemia; Humans; Microbial Sensitivity Tests; Peptides, Cyclic; Prospective Studies

In 20 HIV-patients (17 male homosexuals, 1 male and 1 female i.v. drug abuser and 1 female patient with M. Willebrand-Jürgens) Candida esophagitis was diagnosed by esophagogastroduodenoscopy. Clinically they presented retrosternal pain or an exacerbation of oral candidosis under local antimycotics. The diagnosis of Candida esophagitis was based on histopathologic examination and culture studies of biopsy specimen from macroscopically suspect lesions. Candida antigen was found in the serum of 30% of the patients, immunofluorescence was positive for Candida antibodies in 25%. A CMV- or HSV-esophagitis could be ruled out by direct immunofluorescence, in situ hybridoma experiments and by virus culture assays. In 11/20 patients the Candida esophagitis was the first manifestation of full blown AIDS. 10 patients were treated daily with a combination of amphotericin B 0.4 mg/kg KG and flucytosine 150 mg/kg/KG and 10 patients by oral administration of fluconazole 400 mg/d each for 8 days. Secondary prophylaxis was carried out with 2.4 g/d (24 ml) amphotericin B as oral suspension in the amphotericin group and with 50 mg/d fluconazole p.o. in the fluconazole group. Both therapy regimens showed a complete remission in a control esophagogastroduodenoscopy after 10 days. Side effects were only moderate. After an observation period between 7-24 months there were three relapses in the amphotericin group and four in the fluconazole group. After 24 months 10 patients had died, a rate comparable to that after Pneumocystis carinii pneumonia. In total, there is no difference between both therapy regimens, the oral administration of fluconazole once a day allowed treatment as an outpatient and was appreciated by the patients.

Topics: Amphotericin B; Candidiasis; Drug Therapy, Combination; Esophagitis; Female; Fluconazole; Flucytosine; HIV Infections; HIV-1; Humans; Male

To determine the spectrum of esophageal disease responsible for dysphagia/odynophagia in AIDS patients not responding to current oral antifungals, we studied 49 consecutive patients whose esophageal symptoms failed to improve after a minimum of 3 wk of therapy with oral ketoconazole or fluconazole. An esophageal candidiasis resistant to oral antifungals was the most frequent disease found (22 single infections and four mixed with viruses). Viral esophagitis was identified in 13 cases (eight herpes simplex virus and five cytomegalovirus), and an esophagitis of unknown origin was documented in two patients. Other causes of symptoms included peptic esophagitis (four cases), esophageal stenosis (two cases), and Kaposi's sarcoma of the esophagus (one patient). Most patients with esophageal opportunistic infection experienced prompt relief of symptoms and complete endoscopic resolution on the specific antifungal (amphotericin B or fluconazole iv) or antiviral (acyclovir or gancyclovir iv) therapy, with the exception of those with concomitant fungal and viral infection who responded poorly to treatment. We conclude that most AIDS patients with dysphagia/odynophagia who do not respond to oral antifungals have an opportunistic infection of the esophagus. Nevertheless, specific antifungal or antiviral therapy is worthwhile, because it will eradicate, at least temporarily, the causative pathogens in most such patients.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Administration, Oral; Adult; Amphotericin B; Antifungal Agents; Drug Resistance, Microbial; Esophagitis; Female; Fluconazole; Ganciclovir; Humans; Infusions, Intravenous; Ketoconazole; Male; Opportunistic Infections; Prospective Studies; Treatment Outcome

Topics: Amphotericin B; Candidiasis, Oral; Esophagitis; Humans

Topics: Amphotericin B; Candidiasis, Cutaneous; Candidiasis, Oral; Child; Esophagitis; Female; Humans; Ketoconazole; Leukemia, Lymphoid; Male; Nystatin; Thrombocytopenia

Topics: Agranulocytosis; Amphotericin B; Cytarabine; Daunorubicin; Decision Making; Esophagitis; Fever of Unknown Origin; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Mycoses

Five children (aged 11 to 19 years) with lifelong chronic mucocutaneous candidiasis had 12 episodes of esophageal and/or laryngeal candidiasis documented by endoscopy. Symptoms included hoarseness (8/12), dysphagia (6/12), and hemoptysis (1/12). There was poor correlation between oral lesions and esophageal or laryngeal involvement. On fiberoptic endoscopy, the esophagus was involved alone in four episodes (33%), the larynx in two episodes (17%), and both structures in six episodes (50%). In six of eight instances, the esophagram was nondiagnostic or markedly underestimated the extent of inflammation. Intravenous amphotericin B or miconazole resulted in the resolution of these infections for variable periods of time. Repeat endoscopy was used to follow the course of the disease. Aerosolized amphotericin B was effective on one occasion in clearing candidal lesions of the larynx and one small area of the left mainstem bronchus. Oral topical therapy was not beneficial. Since the signs and symptoms of laryngitis or esophagitis are often minimal or absent and complications, including strictures, may arise from chronic inflammation, periodic endoscopy and systemic therapy may be necessary.

Topics: Adolescent; Adult; Amphotericin B; Candidiasis; Candidiasis, Chronic Mucocutaneous; Child; Endoscopy; Esophagitis; Female; Humans; Laryngitis; Male

Topics: Amphotericin B; Ampicillin; Brain Abscess; Candidiasis; Cryptococcosis; Enterobacteriaceae Infections; Esophagitis; Herpes Simplex; Humans; Infections; Meningitis; Meningitis, Listeria; Mucormycosis; Neoplasms; Pharyngitis; Stomatitis; Toxoplasmosis

Topics: Adolescent; Adult; Amphotericin B; Candidiasis; Child, Preschool; Esophageal Stenosis; Esophagitis; Granuloma; Humans; Infant; Male

Topics: Adolescent; Adult; Aged; Amphotericin B; Candida albicans; Candidiasis; Child; Child, Preschool; Endocarditis; Esophagitis; Female; Humans; Laryngitis; Male; Meningitis; Middle Aged; Pneumonia; Stomatitis; Vaginitis

Topics: Adolescent; Adult; Aged; Amphotericin B; Antineoplastic Agents; Candidiasis; Child; Child, Preschool; Esophagitis; Female; Humans; Infant; Male; Middle Aged; Radiography