Nystatin :: therapeutic use
Latest Paper:
Mesh-terms: Anti-Infective Agents :: administration & dosage; Anti-Infective Agents :: pharmacology; Anti-Infective Agents :: therapeutic use; Drug Combinations; Female; Humans; Nifuratel :: administration & dosage; Nifuratel :: pharmacology; Nifuratel :: therapeutic use; Nystatin :: administration & dosage; Nystatin :: pharmacology; Nystatin :: therapeutic use; Vulvovaginitis :: drug therapy; Vulvovaginitis :: microbiology;
Most cited papers:
Ninety-three hospitalizations of 70 patients, who underwent induction chemotherapy for acute leukemia to determine the effectiveness of oral nystatin in preventing oropharyngeal and systemic candidiasis were reviewed. Sixty-two percent of patients who received prophylactic nystatin and 58% of patients who did not receive nystatin developed oropharyngeal candidiasis; 11% of patients who received prophylaxis and 21% of those who did not receive prophylaxis developed systemic candidiasis. The use of oral nystatin did not significantly diminish the risk of developing either type of Candida infection. Oropharyngeal candidiasis occurred more commonly in patients who had severe and prolonged leukopenia, had received more parenteral antibiotics, and had developed chemotherapy-induced mucositis. Systemic candidiasis developed almost exclusively in patients who had prior oropharyngeal candidiasis. Guidelines for the empiric use of amphotericin B in these patients are provided.
Mesh-terms: Administration, Oral; Adult; Candidiasis :: complications; Candidiasis :: prevention & control; Candidiasis, Oral :: complications; Candidiasis, Oral :: prevention & control; Female; Human; Leukemia :: complications; Leukemia, Lymphocytic :: complications; Male; Nystatin :: administration & dosage; Nystatin :: therapeutic use; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S. ;
C C Wang,
R S McClelland,
M Reilly,
J Overbaugh,
S R Emery,
K Mandaliya,
B Chohan,
J Ndinya-Achola,
J Bwayo,
J K Kreiss
Departments of Medicine and Epidemiology, Division of Infectious Diseases, University of Washington, Seattle, WA 98104-2499, USA. chiaw@u.washington.edu
To assess the effect of treatment of vaginal infections on vaginal shedding of cell-free human immunodeficiency virus type 1 (HIV-1) and HIV-1-infected cells, HIV-1-seropositive women were examined before and after treatment of Candida vulvovaginitis, Trichomonas vaginitis, and bacterial vaginosis. For Candida (n=98), vaginal HIV-1 RNA decreased from 3.36 to 2.86 log(10) copies/swab (P<.001), as did the prevalence of HIV-1 DNA (36% to 17%; odds ratio [OR], 2.8; 95% confidence interval [CI], 1.3-6.5). For Trichomonas vaginitis (n=55), HIV-1 RNA decreased from 3.67 to 3.05 log(10) copies/swab (P<.001), but the prevalence of HIV-1 DNA remained unchanged (22%-25%; OR, .8; 95% CI, .3-2.2). For bacterial vaginosis (n=73), neither the shedding of HIV-1 RNA (from 3.11 to 2.90 log(10) copies/swab; P=.14) nor the prevalence of DNA (from 21% to 23%; OR, .8; 95% CI, .3-2. ) changed. Vaginal HIV-1 decreased 3.2- and 4.2-fold after treating Candida and Trichomonas, respectively. These data suggest that HIV-1 transmission intervention strategies that incorporate diagnosis and treatment of these prevalent infections warrant evaluation.
Mesh-terms: Adult; Anti-Bacterial Agents :: therapeutic use; Antitrichomonal Agents :: therapeutic use; Candidiasis :: complications; Candidiasis :: drug therapy; Comparative Study; DNA, Viral :: analysis; Down-Regulation; Female; HIV Infections :: complications; HIV Infections :: transmission; HIV Infections :: virology; HIV Seropositivity :: complications; HIV Seropositivity :: virology; HIV-1 :: genetics; HIV-1 :: isolation & purification; Human; Metronidazole :: therapeutic use; Nystatin :: therapeutic use; Odds Ratio; Prospective Studies; RNA, Viral :: analysis; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S. ; Trichomonas Vaginitis :: complications; Trichomonas Vaginitis :: drug therapy; Vagina :: pathology; Vagina :: virology; Vaginitis :: complications; Vaginitis :: drug therapy; Vaginitis :: microbiology; Vaginosis, Bacterial :: complications; Vaginosis, Bacterial :: drug therapy; Virus Shedding :: drug effects;
C Lumbreras,
V Cuervas-Mons,
P Jara,
A del Palacio,
V S Turrión,
C Barrios,
E Moreno,
A R Noriega,
C V Paya
Microbiology and Surgery Department, Hospital Doce de Octubre, Universidad Complutense de Madrid, Spain.
A prospective, randomized, multicenter study addressed the safety and efficacy of fluconazole therapy in 143 liver transplant patients. Seventy-six patients received daily oral fluconazole (100 mg), and 67 received nystatin (4 X 10(6) U) during the first 28 days after transplantation. Candida colonization occurred in 25% and 53% of patients in the fluconazole and nystatin groups, respectively (P =.04), and 13% and 34% of patients in the respective groups had Candida infections (P =.022). Of these patients, 10.5% in the fluconazole group and 25.3% in the nystatin group had superficial candidal infections (P =.024). Invasive candidiasis developed in 2 patients in the fluconazole group (2.6%) and 6 in the nystatin group (9. %)(P =.12). There was no increased hepatotoxicity, cyclosporine interaction, or emergence of clinically relevant resistant Candida strains attributable to fluconazole. Thus, oral fluconazole (100 mg) is safe and reduces Candida colonization and infection after liver transplantation.
Mesh-terms: Adult; Antibiotics, Antifungal :: therapeutic use; Antifungal Agents :: therapeutic use; Candidiasis :: diagnosis; Candidiasis :: prevention & control; Female; Fluconazole :: therapeutic use; Human; Liver Transplantation :: adverse effects; Male; Middle Aged; Nystatin :: therapeutic use; Support, Non-U.S. Gov't;
Department of Clinical Immunology, University of Texas M.D. Anderson Hospital and Tumor Institute, Houston.
The therapeutic activity of nystatin (NYS) incorporated in multilamellar liposomes (L-NYS) was studied in vivo. Hale-Stoner mice injected intravenously with various doses of L-NYS and free NYS showed a significant reduction in toxicity of NYS after the NYS was incorporated into liposomes (maximal tolerated doses, 16 and 4 mg/kg of body weight, respectively). The maximal tolerated dose of free NYS had no effect in the treatment of mice infected with Candida albicans, whereas L-NYS at an equivalent dose improved the survival of mice. A marked increase in survival was observed when L-NYS was administered in higher and multiple doses (total doses up to 80 mg/kg). Liposome encapsulation thus provided a means for intravenous administration of NYS, reducing its toxicity and making it an active systemic antifungal agent.
Records of 65 surgical patients with positive fungal blood cultures were reviewed to address risk, overall mortality, and treatment. Negative urine cultures did not rule out sepsis. Staphylococcus epidermidis sepsis was present in 27 (42%) of the patients. In 70% of whom it occurred before or during fungemia. Increased mortality correlated with the use of multiple antibiotics, antibiotic use for prolonged periods, and with associated bacterial sepsis. Stopping antibiotic therapy did not reduce mortality. Amphotericin B reduced mortality in patients with dissemination, indicating that it is the treatment of choice for disseminated fungemia and that antibiotic therapy should not be discontinued when concomitant bacterial sepsis is present.
Mesh-terms: Adolescent; Adult; Aged; Amphotericin B :: therapeutic use; Anti-Bacterial Agents :: adverse effects; Blood :: microbiology; Child; Child, Preschool; Female; Fungi :: drug effects; Fungi :: isolation & purification; Human; Infant; Male; Middle Aged; Mycoses :: complications; Mycoses :: drug therapy; Mycoses :: mortality; Nystatin :: therapeutic use; Postoperative Complications :: drug therapy; Postoperative Complications :: etiology; Postoperative Complications :: mortality; Staphylococcal Infections :: complications; Staphylococcal Infections :: drug therapy;
Arthur J Matas,
Raja Kandaswamy,
Kristen J Gillingham,
Lois McHugh,
Hassan Ibrahim,
Bertram Kasiske,
Abhinav Humar
Department of Surgery, University of Minnesota, Minneapolis, USA. matas001@umn.edu
Concern persists that prednisone-free maintenance immunosuppression in kidney transplant recipients will be associated with an increase in late allograft dysfunction and graft loss. We herein report 5-year follow-up of a trial of prednisone-free maintenance immunosuppression. From October 1, 1999, through January 31, 2005, at our center, 589 kidney transplant recipients were treated with a protocol incorporating discontinuation of their prednisone on postoperative day 6. At 5 years, actuarial patient survival was 91%; graft survival, 84%; death-censored graft survival, 92%; acute rejection-free graft survival, 84% and chronic rejection-free graft survival, 87%. The mean serum creatinine level (+/-SD) at 1 year was 1.6 +/- .6; at 5 years, 1.7 +/- .8. In all, 86% of kidney recipients with functioning grafts remain prednisone-free as of April 30, 2005. As compared with historical controls, recipients on prednisone-free maintenance immunosuppression had a significantly lower rate of a number of complications, including cataracts (p < .001), posttransplant diabetes mellitus (p < .001), avascular necrosis (p = .001), and fractures (p = .004). We conclude that prednisone-related side effects can be minimized in a protocol incorporating prednisone-free maintenance immunosuppression. Five-year graft outcome remains good.
Mesh-terms: Anti-Infective Agents :: therapeutic use; Antifungal Agents :: therapeutic use; Antiviral Agents :: therapeutic use; Cataract :: etiology; Clotrimazole :: therapeutic use; Cohort Studies; Creatinine :: blood; Dapsone :: therapeutic use; Diabetes Mellitus :: etiology; Fractures, Bone :: etiology; Ganciclovir :: analogs & derivatives; Ganciclovir :: therapeutic use; Graft Rejection; Graft Survival; Humans; Immunosuppression; Immunosuppressive Agents :: administration & dosage; Immunosuppressive Agents :: therapeutic use; Kidney Transplantation :: methods; Necrosis :: etiology; Nystatin :: therapeutic use; Pentamidine :: therapeutic use; Prednisone :: administration & dosage; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. ; Time Factors; Transplantation, Homologous :: methods; Treatment Outcome; Trimethoprim-Sulfamethoxazole Combination :: therapeutic use;
In a randomized trial we compared ketoconazole (400 mg once daily, 27 patients) and nystatin (3 X 10(6) units four times daily, 29 patients) for prevention of fungal infection in neutropenic patients undergoing marrow transplantation in a protective environment. Fewer weekly surveillance cultures contained Candida species in ketoconazole recipients than in nystatin recipients (70 [26%] of 274 vs. 151 [47%] of 322; P less than .001). When all fungi were considered, the difference in colonization was less but was still significant (117 [43%] of 274 vs. 173 [54%] of 322; P =.01), primarily due to increased colonization of the rectum with Torulopsis glabrata among ketoconazole recipients (P less than .001). No difference in the incidence of local mucosal infection was seen. Two disseminated fungal infections occurred, both in nystatin recipients. Compliance with ketoconazole was significantly better than was compliance with nystatin (96% vs. 68%; P less than .001), but similar effects on colonization were found in an analysis adjusting for compliance. Ketoconazole was better tolerated and more effective than nystatin in reducing colonization due to Candida species but was also associated with significantly increased rates of colonization with T. glabrata.
Mesh-terms: Agranulocytosis :: complications; Candida albicans :: growth & development; Candida albicans :: isolation & purification; Candidiasis :: microbiology; Candidiasis :: prevention & control; Clinical Trials; Comparative Study; Environment, Controlled; Human; Ketoconazole :: therapeutic use; Mycoses :: etiology; Mycoses :: microbiology; Mycoses :: prevention & control; Neutropenia :: complications; Nystatin :: therapeutic use; Patient Compliance; Random Allocation; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S. ;
Meta-analyses may become biased if the reported data in the individual trials are biased and if overlap among trials cannot be identified. We describe the unanticipated problems we encountered in collecting data for a meta-analysis comparing a new antifungal agent, fluconazole, with amphotericin B in patients with cancer complicated by neutropenia. In 3 large trials that comprised 43% of the patients identified for the meta-analysis, results for amphotericin B were combined with results for nystatin in a "polyene" group. Because nystatin is recognized as an ineffective drug in these circumstances, this approach creates a bias in favor of fluconazole. Furthermore, 79% of the patients were randomized to receive oral amphotericin B, which is poorly absorbed and not an established treatment, in contrast to intravenous amphotericin B, which was administered in 4 of 5 placebo-controlled trials, or 86% of patients. It was unclear whether there was overlap among the "polyene" trials, and it is possible that results from single-center trials were included in multicenter trial reports. We were unable to obtain information to clarify these issues from the trial authors or the manufacturer of fluconazole. Two of 11 responding authors replied that the data were with the drug manufacturer and two indicated that they did not have access to their data because of change of affiliation. In the meta-analyses, fluconazole and amphotericin B (mostly given orally) had similar effects (13 trials), whereas nystatin was no better than placebo (3 trials). Since individual trials are rarely conclusive, investigators, institutions, and pharmaceutical companies should provide essential details about their work to ensure that meta-analyses can accurately reflect the studies conducted and that patients will realize maximum benefits from treatments. We recommend that investigators keep copies of their trial data to help facilitate accurate and unbiased meta-analyses.
Mesh-terms: Amphotericin B :: therapeutic use; Antifungal Agents :: therapeutic use; Fluconazole :: therapeutic use; Human; Meta-Analysis; Mycoses :: complications; Mycoses :: drug therapy; Neoplasms :: complications; Neutropenia :: complications; Nystatin :: therapeutic use; Opportunistic Infections :: complications; Opportunistic Infections :: drug therapy; Publication Bias; Randomized Controlled Trials; Research Design; Support, Non-U.S. Gov't;
S H Miyasaki,
J B Hicks,
D Greenspan,
I Polacheck,
L A MacPhail,
T C White,
N Agabian,
J S Greenspan
Department of Stomatology, University of California, San Francisco 94143-0512.
Restriction fragment polymorphism analysis was used to investigate the identity and genotypic relatedness of Candida albicans strains isolated from human immunodeficiency virus (HIV)-infected patients with or without oral candidiasis and from some of their sexual partners. Use of the species-specific DNA probe Ca3 revealed that most subjects carried a single distinct C. albicans strain throughout the course of the study, during both symptomatic and asymptomatic periods. Sexual partners were more likely to carry the same or similar C. albicans isolates than unrelated subjects, raising the possibility of transmission via intimate contact. One patient appeared to acquire his partner's isolate, which then became predominant in both partners in subsequent isolations. These findings indicate that recurrent oral candidiasis is usually caused by a single persistent strain unique to each patient, but that in some cases transmission via intimate contact may occur between sexual partners.
Mesh-terms: AIDS-Related Opportunistic Infections :: drug therapy; AIDS-Related Opportunistic Infections :: microbiology; Blotting, Southern; Candida albicans :: classification; Candida albicans :: genetics; Candida albicans :: isolation & purification; Candidiasis :: drug therapy; Candidiasis :: etiology; Candidiasis :: microbiology; DNA, Fungal :: genetics; DNA, Fungal :: isolation & purification; Female; Genome, Fungal; HIV Seropositivity :: microbiology; Homosexuality; Human; Ketoconazole :: therapeutic use; Male; Mouth :: microbiology; Nystatin :: therapeutic use; Polymorphism (Genetics) ; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S. ;
Mesh-terms: Acrylic Resins; Adult; Aged; Anti-Bacterial Agents :: therapeutic use; Candidiasis, Oral :: drug therapy; Chromium Alloys; Cytodiagnosis; Denture, Complete :: adverse effects; Denture, Partial, Removable :: adverse effects; Drug Resistance, Microbial; Female; Human; Hypersensitivity; Male; Middle Aged; Nystatin :: therapeutic use; Palate; Stomatitis :: diagnosis; Stomatitis :: drug therapy; Stomatitis :: etiology; Stomatitis :: microbiology; Stomatitis :: therapy; Tissue Conditioning (Dental) ;
