A systematic review of the effectiveness of antifungal drugs for the prevention and treatment of oropharyngeal candidiasis in HIV-positive patients.
OBJECTIVE
A systematic review of randomized clinical trials published between 1966 and April 2000 was undertaken to determine the strength of evidence for the effectiveness of antifungal drugs (nystatin, clotrimazole, amphotericin B, fluconazole, ketoconazole, and itraconazole) to prevent and treat oral candidiasis in human immunodeficiency virus-positive patients.


METHODS
An automated database search identified 366 articles. Six met inclusion and exclusion criteria with respect to prophylaxis; 12 met criteria for treatment of oral candidiasis.


RESULTS
The evidence for the prophylactic efficacy of fluconazole is good, although insufficient to draw conclusions about the other antifungals. Evidence for treatment effectiveness is insufficient for amphotericin B but good for nystatin, clotrimazole, fluconazole, ketoconazole, and itraconazole.


CONCLUSIONS
Suggestions for strengthening the evidence base include the following: use of larger, more well-defined groups; control for immunologic status, viral load, history of oral candidiasis, past exposure to antifungals, baseline oral Candida carriage, drug interactions, and antiretroviral therapy; and consistent use of compliance monitors, fungal speciation, and susceptibility testing.
Patton
L L
LL
Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450, USA. Lauren_Patton@dentistry.unc.edu
Bonito
A J
AJ
Shugars
D A
DA
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000517:prevention & control*; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy / Q000517:prevention & control*; D002180:Candidiasis, Oral / Q000188:drug therapy / Q000517:prevention & control*; D003022:Clotrimazole / Q000627:therapeutic use; D019992:Databases as Topic; D015725:Fluconazole / Q000627:therapeutic use; D006679:HIV Seropositivity / Q000382:microbiology; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D007654:Ketoconazole / Q000627:therapeutic use; D009761:Nystatin / Q000627:therapeutic use; D009960:Oropharynx / Q000382:microbiology*; D010608:Pharyngeal Diseases / Q000382:microbiology*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D013223:Statistics as Topic; D016896:Treatment Outcome
D000935:Antifungal Agents; D009761:Nystatin; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole; D003022:Clotrimazole; D007654:Ketoconazole