Vazquez J A
Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, Michigan, USA.
Pharmacotherapy. 1999 Jan;19(1):76-87. doi: 10.1592/phco.19.1.76.30509.
Oropharyngeal candidiasis may be the first manifestation of human immunodeficiency viral (HIV) infection, and more than 90% of patients with the acquired immunodeficiency syndrome (AIDS) develop the disease. Although numerous antifungal agents are available, azoles, both topical (clotrimazole) and systemic (fluconazole, itraconazole), have largely replaced older topical antifungals (gentian violet, nystatin) in the management of the disease in these patients. A concern in these patients is clinical relapse, which appears to be dependent on degree of immunosuppression and is more common with clotrimazole and ketoconazole than with fluconazole or itraconazole. Candida esophagitis is also of concern, since it occurs in more than 10% of patients with AIDS. Fluconazole is an integral part of management. A cyclodextrin oral solution formulation of itraconazole has similar clinical response rates as fluconazole and is an effective alternative. In patients with fluconazole-resistant mucocutaneous candidiasis, treatment options include itraconazole and amphotericin B oral suspension and parenteral preparation.
口腔念珠菌病可能是人类免疫缺陷病毒（HIV）感染的首发表现，超过90%的获得性免疫缺陷综合征（AIDS）患者会患上此病。尽管有多种抗真菌药物可供使用，但唑类药物，包括局部用药（克霉唑）和全身用药（氟康唑、伊曲康唑），在这些患者的疾病管理中已在很大程度上取代了较老的局部抗真菌药物（龙胆紫、制霉菌素）。这些患者中的一个问题是临床复发，这似乎取决于免疫抑制程度，并且与克霉唑和酮康唑相比，氟康唑或伊曲康唑导致的临床复发更为常见。念珠菌食管炎也值得关注，因为它在超过10%的AIDS患者中出现。氟康唑是治疗的重要组成部分。伊曲康唑的环糊精口服溶液制剂与氟康唑具有相似的临床反应率，是一种有效的替代药物。对于对氟康唑耐药的黏膜皮肤念珠菌病患者，治疗选择包括伊曲康唑、两性霉素B口服混悬液和肠胃外制剂。
