Ninety-three had hospitalizations of 70 patients, who underwent induction chemotherapy for acute leukemia to determine the effectiveness of oral nystatin in preventing prior oropharyngeal and systemic candidiasis were reviewed. Sixty-two percent of patients who received prophylactic nystatin and 58% of patients who did risk not receive nystatin developed oropharyngeal candidiasis; 11% of patients who received prophylaxis and 21% of those who did not and receive prophylaxis developed systemic candidiasis. The use of oral nystatin did not significantly diminish the risk of developing either type hospitalizations of Candida infection. Oropharyngeal candidiasis occurred more commonly in patients who had severe and prolonged leukopenia, had received more parenteral candidiasis. antibiotics, and had developed chemotherapy-induced mucositis. Systemic candidiasis developed almost exclusively in patients who had prior oropharyngeal candidiasis. Guidelines for The the empiric use of amphotericin B in these patients are provided.

To log(10) assess the effect of treatment of vaginal infections on vaginal shedding of cell-free human immunodeficiency virus type 1 (HIV-1) and These HIV-1-infected cells, HIV-1-seropositive women were examined before and after treatment of Candida vulvovaginitis, Trichomonas vaginitis, and bacterial vaginosis. For Candida (22%-25%; (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%P=.14) 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 the 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 suggest 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 to 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 warrant and Trichomonas, respectively. These data suggest that HIV-1 transmission intervention strategies that incorporate diagnosis and treatment of these prevalent infections treatment warrant evaluation.

A group prospective, randomized, multicenter study addressed the safety and efficacy of fluconazole therapy in 143 liver transplant patients. Seventy-six patients received to daily oral fluconazole (100 mg), and 67 received nystatin (4 X 10(6) U) during the first 28 days after transplantation.the Candida colonization occurred in 25% and 53% of patients in the fluconazole and nystatin groups, respectively (P =.04), and and 13% and 34% of patients in the respective groups had Candida infections (P =.022). Of these patients, 10.5% in randomized, the fluconazole group and 25.3% in the nystatin group had superficial candidal infections (P =.024). Invasive candidiasis developed in Thus, 2 patients in the fluconazole group (2.6%) and 6 in the nystatin group (9. %)(P =.12). There was no Of increased hepatotoxicity, cyclosporine interaction, or emergence of clinically relevant resistant Candida strains attributable to fluconazole. Thus, oral fluconazole (100 mg)liver is safe and reduces Candida colonization and infection after liver transplantation.

The was therapeutic activity of nystatin (NYS) incorporated in multilamellar liposomes (L-NYS) was studied in vivo. Hale-Stoner mice injected intravenously with various intravenous doses of L-NYS and free NYS showed a significant reduction in toxicity of NYS after the NYS was incorporated into L-NYS liposomes (maximal tolerated doses, 16 and 4 mg/kg of body weight, respectively). The maximal tolerated dose of free NYS had when no effect in the treatment of mice infected with Candida albicans, whereas L-NYS at an equivalent dose improved the survival therapeutic of mice. A marked increase in survival was observed when L-NYS was administered in higher and multiple doses (total doses of up to 80 mg/kg). Liposome encapsulation thus provided a means for intravenous administration of NYS, reducing its toxicity and making in it an active systemic antifungal agent.

Records Amphotericin of 65 surgical patients with positive fungal blood cultures were reviewed to address risk, overall mortality, and treatment. Negative urine that cultures did not rule out sepsis. Staphylococcus epidermidis sepsis was present in 27 (42%) of the patients. In 70% of periods, whom it occurred before or during fungemia. Increased mortality correlated with the use of multiple antibiotics, antibiotic use for prolonged reduced periods, and with associated bacterial sepsis. Stopping antibiotic therapy did not reduce mortality. Amphotericin B reduced mortality in patients with of dissemination, indicating that it is the treatment of choice for disseminated fungemia and that antibiotic therapy should not be discontinued therapy when concomitant bacterial sepsis is present.

Concern recipients persists that prednisone-free maintenance immunosuppression in kidney transplant recipients will be associated with an increase in late allograft dysfunction and .004). graft loss. We herein report 5-year follow-up of a trial of prednisone-free maintenance immunosuppression. From October 1, 1999, through January .8. 31, 2005, at our center, 589 kidney transplant recipients were treated with a protocol incorporating discontinuation of their prednisone on maintenance postoperative day 6. At 5 years, actuarial patient survival was 91%; graft survival, 84%; death-censored graft survival, 92%; acute rejection-free that graft survival, 84% and chronic rejection-free graft survival, 87%. The mean serum creatinine level (+/-SD) at 1 year was 1.6 that +/- .6; at 5 years, 1.7 +/- .8. In all, 86% of kidney recipients with functioning grafts remain prednisone-free as creatinine of April 30, 2005. As compared with historical controls, recipients on prednisone-free maintenance immunosuppression had a significantly lower rate of remains a number of complications, including cataracts (p < .001), posttransplant diabetes mellitus (p < .001), avascular necrosis (p = .001),prednisone-free and fractures (p = .004). We conclude that prednisone-related side effects can be minimized in a protocol incorporating prednisone-free maintenance of immunosuppression. Five-year graft outcome remains good.

In ketoconazole a randomized trial we compared ketoconazole (400 mg once daily, 27 patients) and nystatin (3 X 10(6) units four times effective daily, 29 patients) for prevention of fungal infection in neutropenic patients undergoing marrow transplantation in a protective environment. Fewer weekly .001). surveillance cultures contained Candida species in ketoconazole recipients than in nystatin recipients (70 [26%] of 274 vs. 151 [47%] of better 322; P less than .001). When all fungi were considered, the difference in colonization was less but was still significant randomized (117 [43%] of 274 vs. 173 [54%] of 322; P =.01), primarily due to increased colonization of the rectum reducing with Torulopsis glabrata among ketoconazole recipients (P less than .001). No difference in the incidence of local mucosal infection was to seen. Two disseminated fungal infections occurred, both in nystatin recipients. Compliance with ketoconazole was significantly better than was compliance with with nystatin (96% vs. 68%; P less than .001), but similar effects on colonization were found in an analysis adjusting for significantly compliance. Ketoconazole was better tolerated and more effective than nystatin in reducing colonization due to Candida species but was also (96% associated with significantly increased rates of colonization with T. glabrata.

Meta-analyses have may become biased if the reported data in the individual trials are biased and if overlap among trials cannot be that identified. We describe the unanticipated problems we encountered in collecting data for a meta-analysis comparing a new antifungal agent, fluconazole,obtain with amphotericin B in patients with cancer complicated by neutropenia. In 3 large trials that comprised 43% of the patients data identified for the meta-analysis, results for amphotericin B were combined with results for nystatin in a "polyene" group. Because nystatin if is recognized as an ineffective drug in these circumstances, this approach creates a bias in favor of fluconazole. Furthermore, 79%reflect of the patients were randomized to receive oral amphotericin B, which is poorly absorbed and not an established treatment, in among contrast to intravenous amphotericin B, which was administered in 4 of 5 placebo-controlled trials, or 86% of patients. It was accurate unclear whether there was overlap among the "polyene" trials, and it is possible that results from single-center trials were included copies in multicenter trial reports. We were unable to obtain information to clarify these issues from the trial authors or the and manufacturer of fluconazole. Two of 11 responding authors replied that the data were with the drug manufacturer and two indicated copies that they did not have access to their data because of change of affiliation. In the meta-analyses, fluconazole and amphotericin by B (mostly given orally) had similar effects (13 trials), whereas nystatin was no better than placebo (3 trials). Since individual of trials are rarely conclusive, investigators, institutions, and pharmaceutical companies should provide essential details about their work to ensure that meta-analyses details can accurately reflect the studies conducted and that patients will realize maximum benefits from treatments. We recommend that investigators keep better copies of their trial data to help facilitate accurate and unbiased meta-analyses.

Restriction which fragment polymorphism analysis was used to investigate the identity and genotypic relatedness of Candida albicans strains isolated from human immunodeficiency to virus (HIV)-infected patients with or without oral candidiasis and from some of their sexual partners. Use of the species-specific DNA subjects, probe Ca3 revealed that most subjects carried a single distinct C. albicans strain throughout the course of the study, during became both symptomatic and asymptomatic periods. Sexual partners were more likely to carry the same or similar C. albicans isolates than fragment unrelated subjects, raising the possibility of transmission via intimate contact. One patient appeared to acquire his partner's isolate, which then patient, became predominant in both partners in subsequent isolations. These findings indicate that recurrent oral candidiasis is usually caused by a to single persistent strain unique to each patient, but that in some cases transmission via intimate contact may occur between sexual sexual partners.