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Reply: Weekly Fluconazole for Preventing Mucosal Candidiasis in HIV Infection
- Paula Schuman, MD, MPH; and
- Jack D. Sobel, MD
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IN RESPONSE:
We share Dr. Baily's concern about the potential for the emergence of resistant candidiasis in patients receiving fluconazole prophylaxis. Although women in the treatment group of our study did not have more episodes of resistant candidiasis than those in the placebo group, we do not, as Dr. Baily says, recommend “widespread use of this regimen.” We suggest that prophylaxis be considered as a therapeutic option only in persons at high risk for recurrence of mucosal candidiasis. Thirty percent of women studied reported two or more episodes of vaginal candidiasis in the year before study entry and were more likely to have new episodes during the study than were women who reported fewer episodes of vaginitis. Women who find these infections extremely troublesome, particularly those who have had four or more documented episodes of vaginal candidiasis in the previous year, should be made aware of the potential risks and benefits of antifungal prophylaxis.
Paula Schuman, MD, MPH
Jack D. Sobel, MD
Wayne State University School of Medicine; Detroit, MI 48201
- Copyright ©2004 by the American College of Physicians
