title: Is empiric therapy with fluconazole appropriate for esophageal candidiasis?
abstract: We studied the prevalence of fluconazole resistance in esophageal candidiasis. Patients with suspected esophageal candidiasis during gastroscopy underwent culture of white plaques. Minimum inhibitory concentration (MIC) >64 μg/mL of fluconazole for Candida was indicative of resistance. Sensitivity of itraconazole was tested in a subset of resistant strains. Sixty-five patients were included. Mean (SD) age was 50.03 (13.5) years and 67.7 % were males. Predisposing factors for candidiasis were found in 42 (64.6 %) patients. C. albicans was identified in 64 (97.4 %) patients and C. glabrata in one patient. Fluconazole resistance was seen in 38 (59.4 %) patients with C. albicans and also in the one patient with C. glabrata. All the fluconazole resistant isolates of C. albicans had MIC >128 μg/mL suggesting very high resistance. Twelve patients with fluconazole resistance had itraconazole resistance as well. The study shows a high rate of fluconazole resistance in patients with esophageal candidiasis.
authors.affiliation: Department of Gastrointestinal Sciences, Christian Medical College, Vellore, 632 004, India, drsaji@yahoo.com.
authors.forename: Kattiparambil Gangadharan
authors.initials: KG
authors.lastname: Sajith
authors.forename: Amit Kumar
authors.initials: AK
authors.lastname: Dutta
authors.forename: Rani Diana
authors.initials: RD
authors.lastname: Sahni
authors.forename: Saritha
authors.initials: S
authors.lastname: Esakimuthu
authors.forename: Ashok
authors.initials: A
authors.lastname: Chacko
mesh_terms: D000328:Adult; D002176:Candida albicans / Q000187:drug effects* / Q000302:isolation & purification; D041221:Candida glabrata / Q000187:drug effects / Q000302:isolation & purification; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology*; D025141:Drug Resistance, Fungal; D004935:Esophageal Diseases / Q000188:drug therapy* / Q000382:microbiology*; D005260:Female; D015725:Fluconazole / Q000494:pharmacology* / Q000627:therapeutic use*; D006801:Humans; D017964:Itraconazole / Q000494:pharmacology; D008297:Male; D008875:Middle Aged
chemical_list: D017964:Itraconazole; D015725:Fluconazole