Candida albicans is responsible for most
fungal infections in humans.
Fluconazole is well established as a first-line management option for the treatment and prophylaxis of localized and systemic C. albicans
infections.
Fluconazole exhibits predictable pharmacokinetics and is effective, well tolerated and suitable for use in most patients with C. albicans
infections, including children, the elderly and those with impaired immunity. Prophylactic administration of
fluconazole can help to prevent
fungal infections in patients receiving cytotoxic
cancer therapy. The increasing use of
fluconazole for the long-term prophylaxis and treatment of recurrent oral candidosis in
AIDS patients has led to the emergence of C. albicans
infections that are not responsive to conventional doses. Second-line
therapy with a wider spectrum antifungal, such as
itraconazole, should be sought if treatment with
fluconazole fails. A
solution formulation of
itraconazole has recently been introduced to overcome the poor and variable absorption of its original
capsule formulation. Efficacy and tolerability studies in HIV-positive or immunocompromised patients with C. albicans
infections have shown that, although
itraconazole solution is as effective as
fluconazole, it is less well tolerated as first-line
therapy.
Itraconazole solution can be effective in
AIDS patients with C. albicans
infections that are non-responsive to
fluconazole. No efficacy or tolerability data are available on the use of
itraconazole solution in children or the elderly.