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When candida is resistant
Mar 30, 2000

I have candida (oral, vaginal, and esophageal) that is resistant to both Diflucan and Nystatin. I started IV amphotericin about a month ago, and am doing 50mg, 3xweekly. I have some improvement, but I had so hoped for eradication. If the ampho fails me, what other options are available? In addition (and not to sound grim) but a person can die from candida, can't they? What should a person expect? By the way, T-cell count is 4 and vl 500,000+. Any suggestions are appreciated.

Response from Dr. Feinberg

Resistant candida is a difficult problem, but not one that people usually die of. Besides the discomfort, maintaining your weight will be the biggest issue. In addition to amphotericin B, there are several lipid-associated forms of ampho b which can be less toxic to your kidneys. There is an experimental drug called MK-0991 made by Merck that is available through what is called a "compassionate release protocol". I have used it successfully in a patient with esophageal candidiasis that was resistant to amphotericin, so there are other options. Also, you might see a faster response if you took the ampho b more often (like 5 days/week or daily), although you might also have more side effects.

Your very low CD4 cell count and very high viral load are part of the overall problem here. You don't say whether you are currently on HIV medicines, but I think you should be. If your viral load were better controlled and your CD4 cells had a chance to increase, that might be the most significant part of treating your resistant candida. If you're on medications now but they're not working, you should ask your doctor to do a resistance test, so a better choice of medicines can be made. If you're not on any HIV meds, then I urge you to reconsider. Treating the HIV will make it easier to treat the resistant candida.

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