Treatment of azole-resistant oropharyngeal candidiasis with topical amphotericin B.
OBJECTIVE
To report a case of successful treatment of azole-refractory oropharyngeal candidiasis with topical amphotericin B.


METHODS
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.


CONCLUSIONS
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.


CONCLUSIONS
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.
College of Pharmacy, University of Kentucky, Lexington, Kentucky 40536-0293, USA.
Shellee A
SA
Grim
Kelly M
KM
Smith
Frank
F
Romanelli
Ighovwerha
I
Ofotokun
D000287:Administration, Topical; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D001393:Azoles / Q000494:pharmacology*; D002180:Candidiasis, Oral / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D025141:Drug Resistance, Fungal; D004941:Esophagitis / Q000150:complications / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans
D000935:Antifungal Agents; D001393:Azoles; D000666:Amphotericin B