Topical polyene antifungals in hematopoietic cell transplant patients: tolerability and efficacy.
OBJECTIVE
The effectiveness of amphotericin B oral suspension versus nystatin oral suspension for the prevention of oral colonization by Candida in hematopoietic cell transplant (HCT) patients was examined.


METHODS
Prior to hematopoietic cell infusion, 40 patients receiving systemic fluconazole for prophylaxis were randomized to receive either amphotericin B oral suspension or nystatin oral suspension, q.i.d. The study continued to day 21 or until the patient was discharge from the hospital or withdrawn from the study. Oral examinations were conducted twice weekly, and adverse events and compliance were recorded. Cultures were taken for quantitative counts and species identification. Candida isolates were assessed for resistance to the oral antifungal agents. Blood was collected for assessment of amphotericin B levels.


CONCLUSIONS
Ulcerative mucositis occurred in 84.6% of patients undergoing HCT, and no correlation was observed between the severity of mucositis and the presence of oral Candida and the severity of mucositis. Systemic and topical antifungal treatment resulted in a decrease in the number of colonized patients (54.8% before treatment; 23.1% during treatment); however, oral colonization was not eliminated. Tolerability of the oral rinse products was limited, with greater noncompliance in the amphotericin B than the nystatin group. Reports of altered taste appeared to be greater in the amphotericin B group. Minimal absorption of amphotericin B was seen following oral rinsing (serum levels 0.12-0.50 microg/ml), and no consistent changes in organism susceptibility to polyenes were seen. The results suggest that topical antifungal rinses may further control oropharyngeal colonization by Candida in patients on systemic antifungals receiving HCT, but the effect is limited by tolerability and reformulation and should be considered in order to increase compliance.
Epstein
Joel B
JB
Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois at Chicago, 801 S. Paulina Street, Room 556, Chicago, IL 60612-7213, USA. jepstein@uic.edu
Truelove
Edmond L
EL
Hanson-Huggins
Kimberly
K
Mancl
Lloyd A
LA
Chen
Alice
A
Press
Oliver W
OW
Petersdorf
Stephen H
SH
Fritsche
Thomas R
TR
Epstein
Joshua D
JD
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000008:administration & dosage*; D002180:Candidiasis, Oral / Q000188:drug therapy / Q000517:prevention & control*; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D005892:Gingivitis, Necrotizing Ulcerative / Q000382:microbiology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology; D009067:Mouthwashes / Q000627:therapeutic use; D009761:Nystatin / Q000008:administration & dosage*; D011090:Polyenes / Q000008:administration & dosage; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D000935:Antifungal Agents; D009067:Mouthwashes; D011090:Polyenes; D009761:Nystatin; D000666:Amphotericin B; D015725:Fluconazole