Document Detail


Clinical resistance of recurrent Candida albicans vulvovaginitis to fluconazole in the presence and absence of in vitro resistance.
MedLine Citation:
PMID:  12621787     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine if failure of recurrent Candida albicans vulvovaginitis to respond clinically to fluconazole is related to in vitro mycologic resistance. STUDY DESIGN: We compared clinical response to fluconazole with culture and sensitivity data in all cases of recurrent C albicans vulvovaginitis referred to our clinic over an 18-month period. RESULTS: Of 52 patients referred to us with recurring vulvovaginitis, 10 were C albicans culture positive. All 10 had previously responded to fluconazole but subsequently failed fluconazole therapy. All were euglycemic and HIV negative. In 3 of the 10 isolates, the mean inhibitory concentration for fluconazole was > 64 micrograms/mL. The history of response to fluconazole in the 7 patients with susceptible isolates was indistinguishable from that of the 3 with resistant isolates. Five of the 10 patients were given multiagent antifungal therapy. Of 4 patients available for long-term follow-up in this group, all had negative fungal cultures. In contrast, 4 evaluable patients who received maintenance azole therapy were C albicans culture positive at long-term follow-up. CONCLUSION: Recurrent C albicans vulvovaginitis can display clinical resistance to fluconazole that correlates with in vitro resistance in only some cases. We postulate that aberrant host response may play a role in the failure to control fungal colonization with a single fungistatic agent.
Authors:
Colin MacNeill; Judith Weisz; J Christopher Carey
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Journal of reproductive medicine     Volume:  48     ISSN:  0024-7758     ISO Abbreviation:  J Reprod Med     Publication Date:  2003 Feb 
Date Detail:
Created Date:  2003-03-07     Completed Date:  2003-06-04     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0173343     Medline TA:  J Reprod Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  63-8     Citation Subset:  IM    
Affiliation:
Division of Women's Health, Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA. cmacneill@psu.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Antifungal Agents / pharmacology*
Candida albicans / drug effects*,  isolation & purification
Candidiasis / diagnosis,  drug therapy*
Cohort Studies
Drug Resistance, Fungal*
Female
Fluconazole / pharmacology,  therapeutic use*
Follow-Up Studies
Humans
Microbial Sensitivity Tests
Middle Aged
Prospective Studies
Recurrence
Risk Assessment
Treatment Outcome
Vulvovaginitis / drug therapy*,  microbiology*
Grant Support
ID/Acronym/Agency:
P01 AI-37829/AI/NIAID NIH HHS; R21 DE-14047/DE/NIDCR NIH HHS
Chemical
Reg. No./Substance:
0/Antifungal Agents; 86386-73-4/Fluconazole

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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