Change of candidal susceptibilities to fluconazole after arrest of the systematic prophylaxis of oropharyngeal prophylaxis

The efficacy and safety of fluconazole were such that this drug was proposed as secondary prophylaxis of oropharyngeal candidiasis in HIV infected patients. With this exposure, resistance emerged, The results of the susceptibilities of Candida isolated from 154 and 146 patients included into two separated cross-sectional studies (the first with systematic prophylaxis with fluconazole and the second without) were reported. The proportion of C. albicans vs ''non-albicans'' was different : 88/17 vs 98/8 during the first and second period respectively, (p = 0,02). Both the percentage of resistant (5,6 % vs 6,7 %, p = 0,71) and the distribution of the levels of susceptibility of C. albicans did not change significantly. By using a multivariate analysis, the resistance of C. albicans was significantly linked to the cumulate dose of fluconazole (R(2) = 0,23, p = 0,0054). Otherwise, the delay without fluconazole was shorter for patients with resistant strains than for patients with susceptible Candida (1,7 month vs 3,7 month, Log rank test, p = 0,01), indicating the persistance of own strains, These results indicate the need for new drugs which do not share the mecanisms of azole resistance and new therapeutic strategies.