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starting and stopping Spornox

Oct 3, 2001

I've got a CD4 below 20, VL over 400,000, but feel OK. I'm multi-drug resistant, so there aren't a whole lot of options for me. But my question, is regarding thrush. When it's suppressed, I leave it alone, when it acts up, I take Spornox for 2 or 3 days, and it clears. But lately, it's gotten more agressive, and I need Spornox more often. Could my stopping and starting have helped developed a resistance to an ANTIFUNGAL?

Response from Dr. Young

Typically, we try to treat acute flairs of thrush with 7-10 days of antifungals (particularly among individuals with low T cell counts). We do know from a previous ACTG study that the risk of the emergence of resistant Candida increases with low CD4 cells, so with a CD4 cell count of 20, you are particularly at risk.

I would advise you to take a longer course of treatment during acute flairs, but also to inquire with your doctor to see if you could have a susceptibility test run on your thrush to see if it has become resistant to itraconazole. In this circumstance, mycelex or nystatin may be helpful. In extreme cases, we have used amphoteracin topically with some success. Good luck, BY

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