title: Itraconazole cyclodextrin solution: the role of in vitro susceptibility testing in predicting successful treatment of HIV-related fluconazole-resistant and fluconazole-susceptible oral candidosis.
abstract: OBJECTIVE
  This study assessed the ability of in vitro susceptibility testing of clinical Candida isolates to predict in vivo response to itraconazole cyclodextrin solution.
  
  
  METHODS
  One hundred specimens were obtained from HIV-positive patients with oral thrush, of which 72 speciments were from patients who were clinically unresponsive to fluconazole at standard doses and had fluconazole-resistant isolates in vitro. Susceptibility to itraconazole was assessed by measuring the relative growth of an isolate in liquid medium containing a single concentration of itraconazole and then expressing growth in itraconazole as a percentage of growth in antifungal-free medium.
  
  
  CONCLUSIONS
  Where specimens yielded only one isolate, a cut-off relative growth in itraconazole of 68% discriminated between isolates from patients failing to respond clinically to itraconazole solution and those from patients successfully treated with the preparation (specificity 100%; sensitivity 88%). The presence of mixed infection reduced the predictive accuracy of the test. Only 30% of fluconazole-resistant isolates were cross-resistant to itraconazole. No isolates were resistant to itraconazole but susceptible to fluconazole. Non-response to itraconazole solution was attributed to resistant yeast infection in the majority of cases, and this susceptibility method accurately identified specimens from patients unlikely to respond to the drug.
authors.affiliation: Department of HIV & Genito-Urinary Medicine, St Stephen's Centre, Chelsea & Westminster Healthcare NHS Trust, London, UK.
authors.forename: J D
authors.initials: JD
authors.lastname: Cartledge
authors.forename: J
authors.initials: J
authors.lastname: Midgley
authors.forename: B G
authors.initials: BG
authors.lastname: Gazzard
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002175:Candida / Q000187:drug effects*; D002180:Candidiasis, Oral / Q000188:drug therapy* / Q000382:microbiology; D004352:Drug Resistance, Microbial; D015725:Fluconazole / Q000627:therapeutic use*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008826:Microbial Sensitivity Tests; D012680:Sensitivity and Specificity
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole