On t.p.: Degree MSc Dental Science (Community Dentistry) / Thesis (MSc)--Stellenbosch University, 2002. / ENGLISH ABSTRACT:
The purpose of this review was to investigate the management of oral candidiasis in
HIV/AIDS patients and to evaluate the different guidelines that are available for its
management. To achieve this aim, three objectives were identified: (i) to identify and
report on the different interventions used to manage oral candidiasis, in patients with
HIV/AIDS, (ii) to determine the efficacy of these interventions, and (iii) to provide
guidelines for management. A thorough systematic search of the literature was carried
out and all relevant papers were graded into three levels of evidence (A, B, and C) and
scored for quality according to set criteria.
A number of topical and systemic antifungal medications are used to treat oral
candidiasis in HIV-positive patients. These include the poleyne antibiotics, nystatin and
amphotericin B. Milder episodes of oral candidiasis respond to topical therapy with
nystatin, clotrimazole troches or oral ketoconazole. Fluconazole has been extensively
evaluated as a treatment for candidiasis. With HIV-infection, a cure rate of 82% has
been achieved with a daily oral dose of 50 mg. Fluconazole was found to be a better
choice of treatment for relapsing oropharyngeal candidiasis, resulting in either better
cure rates or better prevention of relapse. Intravenous amphotericin B has been found to
be effective therapy in azole refractory candidiasis where it was shown to be safe and
well tolerated.
Topical therapies were found to be effective treatment for uncomplicated oropharyngeal
candidiasis, however patients relapsed more quickly than those treated with oral
systemic antifungal therapy. Overall, nystatin appears less effective than clotrimazole
and the azoles in the treatment of oropharyngeal candidiasis. With regard to the resolution of clinical symptoms, clotrimazole was found to be just as effective as
the azoles, except when patient compliance was poor. Fluconazole-treated patients were
more likely to remain disease-free during the fluconazole follow-up period than with
those treated with other interventions.
Relatively few studies were qualified to address the provision of guidelines for the
management of oral candidiasis in primary health care settings. Most of the studies
found were of moderate and low quality level of evidence. These studies included the
assessment of different guidelines for identification, treatment and dental needs. They
stressed that patients with HN need dentists who will act as primary health care
providers, together with other providers to ensure adequate overall care.
Given the level of interest and importance of candidiasis associated with treatment of
HN -positive patients, it is surprising to find that little high quality research has been
undertaken. As such, it is hoped that this review would provide researchers, oral health
care workers and other health care providers with an overview of the management of
oral candidiasis associated with HN/AIDS. / AFRIKAANSE OPSOMMING:
Die doelstelling van die oorsig was om ondersoek in te stel na die hantering van orale kandidiase in
HIV/AIDS pasiënte asook om die verskillende beskikbare riglyne vir die behandeling daarvan te
evalueer. Ter verwesenliking van hierdie doelstelling is drie doelwitte geïdentifiseer: (i) om die
intervensies wat gebruik word in die hantering van orale kandidiase behandeling te identifiseer, (ii)
om die effektiwiteit van hierdie intervensies te identifiseer en (iii) om op grond hiervan riglyne vir
die hantering voor te stel. 'n Sistematiese literatuursoektog is uitgevoer en alle relevante artikels is
in drie groepe geklassifiseer (A, B en C) op grond van die data kwaliteit.
'n Verskeidenheid topikale en sistemiese antifungale middels word gebruik om orale kandidiase in
HIV-positiewe pasiënte te behandel. 'n Sukseskoers van 82% is met die gebruik van 'n daaglikse
dosis van 50 mg medikament gerapporteer. Fluconazole was die beter keuse van middel vir die
behandeling van terugkerende orofaringeale kandidiase.
Topikale behandeling was effektief in die behandeling van ongekompliseerde orofaringeale
kandidiase, hoewel die kans op terugkeer van die toestand groter was as met die sistemiese middels.
Pasiënte wat met flukonasool behandel is, het 'n groter kans gehad om siektevry te bly vergeleke
met pasiënte op die ander intervensies.
Meeste van die studies was van middelmatige tot lae kwaliteit en gevolglik was dit moeilik om
behandelingsriglyne te stel. Wat egter wel duidelik is, is dat HIV pasiënte primêre mondsorg
benodig wat saam met ander versorging omvattende sorg sal verseker.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/52713 |
| Date | 03 1900 |
| Creators | Albougy, Hany Ahed |
| Contributors | Naidoo, S. (Sudeshni), Stellenbosch University. Faculty of Medicine & Health Sciences. Dept. of Dentistry. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | 74 p. |
| Rights | Stellenbosch University |
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