Journal Reading Gigi

8/11/2019 Journal Reading Gigi

1/20

Serum Itraconazole Concentrations And Clinical

Responses In Candida-associated Denture

Stomatitis Patients Treated With Itraconazole

Solution And Itraconazole Capsules

RR PUTRI AYU HAPSARI

1


2/20

Abstract

The aim of this study was to compare the concentrations

of itraconazole in serum and saliva after treatment with

itraconazole cyclodextrin solution or itraconazole

capsulesin Candida-associated denture stomatitis

patients without evidence of immunodeficiency

2


3/20

40 patient were randomly itraconazole

cyclodextrin solution or itraconazole capsules

100 mg for 15 days On completion of treatment

Serum and saliva samples

itraconazole concentrations measured

3


4/20

Introduction

Candida-associated denture stomatitis is

characterized by chronic erythema and oedema

of the palatal mucosa beneath an upper denture

4


5/20

Patients And Methods

Age Range 29-81

Mean 62 years

9 Male31 Female

5

clinical evidence of denture stoma-titis and positive yeast cultures from both the palatal

mucosa and dorsum of the tongue


6/20

----------------------

Include:

All were edentulous denture wearers with clinical

evidence of denture stoma-titis and positive yeast

cultures from both the palatal mucosa and dorsum of the

tongue

Exclude:

Pregnant, lactating or of child-bearing age and not using

reliable contraception; had impaired renal or hepaticfunction; had used an antifungal agent within the

preceding 10 days

6


7/20

The 40 patients were

randomized

cyclodextrin

solution of

itraconazole

itraconazole

capsules

at a dose

of 100 mg15

days

at a dose

of 100 mg

15

days

7


8/20

itraconazole

solutionitraconazole

capsules after

food

1 h

before

food

All patients

werereviewed

after 15

days

anerythema

meter

8

1 mL of

whole

saliva


9/20

VS

9


10/20

ResultsCyclodextrin group (n= 18)

Capsule group (n= 18)

serum(mg/L)

saliva(mg/L)

time (h)since lastdose

serum(mg/L)

saliva(mg/L)

time (h)since lastdose

1.08 0.16 8.25 0.37 0.00 21

0.75 0.00 19 0.83 0.00 2

0.00 0.00 5.75 1.42 0.00 2.5

1.20 0.00 4 0.87 0.00 2

0.56 0.68 3.5 0.45 0.00 2.25

1.03 0.48 2 1.23 0.00 4.5

0.34 0.00 4.25 0.31 0.00 20

1.03 1.50 7.5 0.93 0.00 1.25

0.68 0.17 2 0.71 0.00 3

1.26 0.07 2 0.21 0.00 5

1.17 0.69 6.5 0.91 0.00 2

0.28 1.04 3 1.24 0.00 28.5

0.00 0.21 5 0.50 0.00 1.25

0.68 0.00 6.5 0.51 1.68 1.75

1.50 0.05 3 0.39 7.40 5

0.73 0.06 3.5 0.34 0.00 1.75

1.48 0.53 2.25 0.39 0.00 3.25

0.50

0.02

2.5

1.09

0.02

4.25

10


11/20

11


12/20

C. albicans

Of the 40 study participants, 18 were infected with more

than one species of yeast

C. glabrata

was found in 12 patients at baseline and persisted post-

treatment in all

Candida tropicalis, Candida krusei, Candidaparapsilosis, Candida guillermondiiand Saccharomyces

cerevisiaewere present in samples from only a few of

the patients at baseline

12


13/20

Discussion

1. Itraconazole Capsules

gastric acidity, the bioavailability of the itraconazole

being reduced in the fasting state or under

conditions of hypochlorhydria

2. Cyclodextrin Solution of Itraconazole

13


14/20

-----------------

Nevertheless, it is interesting to note that

the majority of mycologically cured patients in this

clinical trial had serum itraconazole concentrationsof greater than 0.6 mg/L

whereas most of the mycologically non-cured

patientshad serum itraconazole concentrations of

0.5 mg/L or less

14


15/20


16/20

concentrations of itraconazole in their saliva

(P< 0.001)

cyclodextrin group >itraconazole capsule group

16


17/20

There was no relationship between the serum

and saliva itraconazole concentrations of the

group on the cyclodextrin preparation

(P= 0.704)

17


18/20

CONCLUSIONS

The absorption of itraconazole with the liquid

preparation was no greater than with the

capsules, but itraconazole was more likely to be

found in the saliva on treatment with the liquidpreparation. Itraconazole cyclodextrin solution

and itraconazole capsules were equally effective

in the treatment of denture stomatitis

18


19/20

REFERENCES

Budtz-Jrgensen, E., Stenderup, A. & Grabowski, M. (1975). An epidemiologic study of yeasts in elderly denture

wearers. Community Dentistry and Oral Epidemiology3, 1159.

Budtz-Jrgensen, E. (1974). The significance of Candidaalbicansin denture stomatitis. Scandinavian Journal of

Dental Research82, 15190.

Budtz-Jrgensen, E. (1990). Candida-associated denture stomatitis and angular cheilitis. In Oral Candidosis,

(Samaranayake, L. P. & MacFarlane, T. W., Ed.), pp. 15683. Wright, London.

Cartledge, J. D., Midgeley, J., Youle, M. & Gazzard, B. G. (1994). Itraconazole cyclodextrin solution: effective

treatment for HIV-related candidosis unresponsive to other azole therapy. Journal of Antimicrobial

Chemotherapy33, 10713.

Cartledge, J. D., Midgeley, J. & Gazzard, B. G. (1997). Itraconazole solution: higher serum drug concentrations

and better clinical response rates than the capsule formulation in acquired immunodeficiency syndrome patients

with candidosis. Journal of Clinical Pathology50, 47780.

British Medical Association and Royal Pharmaceutical Society of Great Britain. (1996). Section 5.2Antifungal

Drugs. British National Formulary32, 2626.

Cross, L. J., Bagg, J. & Moseley, H. (1998). Evaluation of an optical instrument for objective assessment of oral

mucosal erythema. Journal of Oral Rehabilitation25, 496501.

Warnock, D. W., Turner, A. & Burke, J. (1988). Comparison of high performance liquid chromatographic and

microbiological methods for determination of itraconazole. Journal of Antimicrobial Chemotherapy21, 93100.

Rex, J. H., Pfaller, M. A., Galgiani, J. N., Bartlett, M. S., Espinel-Ingroff, A., Ghannoum M. A. et al.(1997).

Development of interpretive breakpoints for antifungal susceptibility testing: conceptual framework and analysis of

in vitroin vivo correlation data for fluconazole, itraconazole and candida infections. Clinical Infectious

Diseases24, 23547.

Janssen-Cilag Ltd. (1996). Sporanox liquid. In Sporanox(Itraconazole) in Systemic Fungal Infection.Product

Monograph, pp. 7586. Janssen-Cilag Ltd, Buckinghamshire, UK

19


20/20

THANK YOU

20

Documents

Journal Reading Gigi