Recurrent oropharyngeal
candidiasis is common in patients with
acquired immunodeficiency syndrome and the
acquired immunodeficiency syndrome-related complex. It causes local
pain and discomfort,
loss of taste, and aversion to food and may lead to secondary complications. We examined, in a double-blind study, whether recurrent
thrush could be prevented by prophylaxis. Twenty-five patients with one to four previous
thrush episodes who had no
thrush at the outset of the study were randomized to receive 100 mg of
fluconazole or placebo daily for 12 weeks. If
thrush occurred, prophylaxis was stopped and patients were treated conventionally, after which prophylaxis was resumed. After the randomized study, some patients were given continuous
fluconazole (open phase). In the randomized study,
thrush occurred in eight of 13 placebo-treated patients and none of 12
fluconazole-treated patients. Possible side effects were not different between the groups.
Dermatophytosis and
onychomycosis and cryptococcuria also improved in the
fluconazole-treated patients, and fungal colonization was significantly decreased. One episode of
thrush occurred in the open phase in an intermittently compliant patient (group total, 71.5 patient-months of
fluconazole treatment); in contrast, the 25 patients also had had two episodes of Candida
esophagitis, three of
cryptococcosis, and 13 of
dermatophytosis before entry. Subsequent to entry in the randomized trial, in 92.3 patient-months without
fluconazole, there were 35 episodes of
thrush, one of
esophagitis, one of cryptococcemia, and one of
dermatophytosis, and preexisting
dermatophytosis and
onychomycosis were unchanged or worsened. Individual patients observed with and without
fluconazole treatment also showed its efficacy. In conclusion,
thrush can be prevented in patients with
acquired immunodeficiency syndrome and the
acquired immunodeficiency syndrome-related complex with negligible toxic effects. Larger trials to confirm prevention of all
mycoses with prophylaxis should be considered.