Itraconazole cyclodextrin solution for fluconazole-refractory oropharyngeal candidiasis in AIDS: correlation of clinical response with in vitro susceptibility

AIDS. 1996 Oct;10(12):1369-76. doi: 10.1097/00002030-199610000-00009.


Objective: To evaluate the efficacy of itraconazole cyclodextrin solution in fluconazole-refractory oropharyngeal candidiasis (OPC), and to correlate clinical outcome with in vitro susceptibility and serum azole levels.

Design: A prospective, open-label, intervention study.

Setting: A university hospital, which serves as the provincial HIV referral center.

Patients and interventions: Thirty six HIV-infected individuals referred for fluconazole-refractory OPC were evaluated prospectively between May 1993 and March 1995, including clinical assessment, serum azole levels, and susceptibility testing of Candida spp, isolates. Itraconazole solution was administered orally at a daily dose of 200 mg for 14 days, followed by suppressive therapy. Thirty-four patients were evaluable.

Main outcome measure: Resolution of oral pseudomembranous lesions.

Results: Initial isolates were Candida albicans (n = 33), C. glabrata (n = 1), C. krusei (n = 1), and mixed infection with C. albicans and C. krusei (n = 1). Fluconazole serum levels obtained at the time of failed therapy ranged from 4.7 to 40 mg/l (median, 12.9 mg/l). Itraconazole was generally well tolerated. Clinical responses were observed in 65% (22 out of 34) of evaluable cases. Among the responders, relapse had occurred within 2 months for four (36%) out of 11 cases who continued with follow-up. The median fluconazole minimal inhibitory concentration (MIC) was 64 mg/l for isolates from fluconazole-refractory cases, compared with a median of 0.5 mg/l for control isolates (P = 0.002). The median itraconazole MIC for isolates from fluconazole-refractory cases was 1.25 mg/l, compared with a median of 0.078 mg/l for controls (P = 0.011).

Conclusion: A correlation between clinical response and in vitro susceptibility was clearly demonstrated for fluconazole, but not for itraconazole. Itraconazole cyclodextrin solution may be effective for fluconazole-refractory OPC and should be considered prior to salvage therapy with intravenous amphotericin B.

Publication types

  • Clinical Trial

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy*
  • Adult
  • Candidiasis, Oral / drug therapy*
  • Cyclodextrins*
  • Drug Resistance, Microbial
  • Female
  • Fluconazole / blood
  • Fluconazole / therapeutic use*
  • Humans
  • Itraconazole / administration & dosage*
  • Itraconazole / blood
  • Itraconazole / therapeutic use
  • Male
  • Middle Aged
  • Oropharynx
  • Prospective Studies
  • Solutions


  • Cyclodextrins
  • Solutions
  • Itraconazole
  • Fluconazole