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1996-01-30
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Document 0485
DOCN M9610485
TI Therapy for opportunistic fungal infections: past, present and future.
DT 9601
AU Stevens DA; Department of Medicine, Santa Clara Valley Medical Centre,;
Stanford University Medical School, San Jose, California; 95128-2699,
USA.
SO Indian J Cancer. 1995 Mar;32(1):1-9. Unique Identifier : AIDSLINE
MED/96038073
AB The field of antifungal chemotherapy is presently rapidly moving. It
began in 1903, with the successful use of potassium iodide (KI). Then
there was little progress for 50 years, when in 1951, nystatin was
introduced, the first useful polyene. Four years later amphotericin B
followed, which is still the historical standard against which new
systemic antifungals are compared. Except for the development of
flucytosine, there was little progress until the early 1970s and the
development of the azole drugs. The present era, which is characterized
largely by the modifications of azole drugs, began with ketoconazole and
brought agents which can be given orally and have increasing potency,
decreasing toxicity and a broader spectrum of activity. Recent studies
have examined ways to ameliorate the well-known toxicities of
amphotericin B. A new approach has been to complex the drug with lipids
or entrap it in liposomes. Itraconazole is a broad-spectrum oral
triazole whose greatest advantages over the imidazoles are in its
activity against aspergillosis and cryptococcosis, though it is also
efficacious against the endemic deep mycoses. Fluconazole is a
broad-spectrum triazole. It has been shown to be efficacious in various
forms of superficial candidosis, including esophageal disease. We have
shown in a randomized, double-blind, placebo-controlled study that
maintenance therapy can completely prevent thrush in AIDS patients with
recurrent thrush and possibly prevent all deep and superficial mycoses.
Other studies have shown efficacy in cryptococcal meningitis in AIDS
comparable to conventional therapy and with far less toxicity, and also
in prevention of relapse of cryptococcal disease. Early diagnosis of
fungal infections in cancer patients is problematic.(ABSTRACT TRUNCATED
AT 250 WORDS)
DE Acquired Immunodeficiency Syndrome/MICROBIOLOGY Antifungal
Agents/*THERAPEUTIC USE AIDS-Related Opportunistic Infections/DRUG
THERAPY Drug Therapy/TRENDS Human Mycoses/*DRUG THERAPY
Opportunistic Infections/*DRUG THERAPY JOURNAL ARTICLE REVIEW REVIEW,
TUTORIAL
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).