207
Views
2
CrossRef citations to date
0
Altmetric
Original Articles

Therapeutic Options for the Management of Oropharyngeal and Esophageal Candidiasis in HIV/AIDS Patients

Pages 47-59 | Published online: 12 Jan 2015

REFERENCES

  • Odds FC. Candida and Candidosis. A Review and Bibliog-raphy. London: Baillière Tindall; 1988.
  • Kleinegger CL, Lockhart SR, Vargas K, Soil DR. Fre-quency, intensity, species, and strains of oral Candida vary as a function of host age. J Clin Microbiol. 1996;34:2246–2254.
  • Johnston RD, Chick EW, Johnston NS, Jarvis MA. Asymp-tomatic quantitative increase of Candida albicans in the oral cavity: Predisposing conditions. South Med J. 1967;60:1244–1247.
  • Stenderup A, Pedusen GT. Yeast of human origin. Acta Pathol Microbiol Scand. 196254: 462–472.
  • Mackenzie DWR. Yeast from human sources. Sabouraudia. 1962;1:8–15.
  • van’t Wout JW. Fluconazole treatment of candidal infec-tions caused by non-albicans Candida species. Eur J Clin Microbiol Infect Dis. 1996;15:238–242.
  • Barchiesi F, Morbiducci V, Ancarani F. Scalise G. Emer-gence of oropharyngeal candidiasis caused by non-albicans species of Candida in HIV-infected patients. Eur J Epidemiol. 1993;9:455–456.
  • Boerlin P, Boerlin-Petzold F, Goudet J, et al. Candida alb/cans oral isolates from human immunodeficiency vi-rus-infected patients by multilocus enzyme electrophore-sis and DNA fingerprinting. J Clin Microbiol. 1996;34:1235–1248.
  • Bette PG. Pathology of some of the opportunistic infec-tions in acquired immune deficiency syndrome (AIDS). Pathologica. 1985;77:67–75.
  • Chandler FW. Pathology of the mycoses in patients with the acquired immune deficiency syndrome (AIDS). Curr Topics Med Mycol. 1985;1:1–23.
  • Jaffe HW, Bregman DJ, Selik RM. Acquired immune defi-ciency syndrome in the United States: The first 1,000 cases. J Infect Dis. 1983;148:339–345.
  • Stenderup A, Schonheyder H. Mycoses complicating AIDS. Microbiol Sci. 1984;1:219–223.
  • Melbye M, Schonheyder H, Kesters L, et al. Carriage of oral Candida albicans associated with a high number of circulating suppressor T lymphocytes [letter]. J Infect Dis. 1985;152:1356–1357.
  • Schonheyder H, Melbye M, Biggar RJ, Ebbesen P, Newland CY, Stenderup A. Oral yeast flora and antibodies to Candida albicans in homosexual men. Mykosen. 1984;27:539–544.
  • Kalo-Klein A, Witkin SS. Prostaglandin E2 enhances and gamma interferon inhibits germ tube formation in Candida albicans. Infect Immunity. 1990;58: 260–262.
  • Hippocrates CA, Adams F. Epidemics, Book 3. Baltimore,MD: Williams & Wilkins; 1939.
  • Coker RJ, Fisher M, Tomlinson DR. Management of my-coses associated with HIV disease. Int J STD AIDS. 1995;6:408–412.
  • Silverman S Jr, Gallo JW, McKnight ML, Mayer P, deSanz S, Tan MM. Clinical characteristics and management re-sponses in 85 HIV-infected patients with oral candidiasis. Oral Surg Oral Med Oral Pathol Oral Radio/ Endod. 1996;82:402–407.
  • Greenspan D. Treatment of oropharyngeal candidiasis in HIV-positive patients. J Am Acad Dermatol. 1994;31:S51–55.
  • Feigal DW, Katz MH, Greenspan D, et al. The prevalence of oral lesions in HIV-infected homosexual and bisexual men: Three San Francisco epidemiological cohorts. AIDS. 1991;5:519–525.
  • Powderly, WG, Robinson K, Keath EJ. Molecular typing of Candida albicans isolated from oral lesions of HIV-infected individuals. AIDS. 1992;6:81–84.
  • Darouiche RO. Oropharyngeal and esophageal candidi-asis in immunocompromised patients: Treatment issues. Clin Infect Dis. 1998;26:259–274.
  • Glatt AE, Chirgwin K, Landesman SH. Treatment of infec-tions associated with human immunodeficiency virus. N Engl J Med. 1988;318:1439–1448.
  • Selik RM, Starcher ET, Curran JW. Opportunistic diseases reported in AIDS patients: Frequencies, associations, and trends. AIDS. 1987;1:175–182.
  • Vazquez J, Lynch M, Boikov D, Sobel JD. Incidence of in vitro antifungal cross resistance among fluconazole-resis-tant Candida albicans and Torulopsis glabrata isolates [abstract]. Proceedings of the 33rd Annual Meeting. Infect Dis Soc Am. 1995;102.
  • Kozinn PJ, Taschdjian CL, Dragutsky D, et al. Therapy of oral thrush: A comparative evaluation of gentian violet, mycostatin and amphotericin B. Monogr Ther. 1957;2:16–24.
  • Pons V, Greenspan D, Lozada-Nur F, et al. Oropharyngeal candidiasis in patients with AIDS: Randomized compari-son of fluconazole versus nystatin oral suspensions. Clin Infect Dis. 1997;24:1204–1207.
  • Quintiliani R, Owens NJ, Quercia RA, Klimek JJ, Nightin-gale CH. Treatment and prevention of oropharyngeal can-didiasis. Am J Med. 1994;77(suppl 4D):44–48.
  • Yap BS, Bodey GP. Oropharyngeal candidiasis treated with a troche form of clotrimazole. Arch Intern Med. 1979;139:656–657.
  • Shectman LB, Funaro L, Robin T, Bottone EJ, Cuttner J. Clotrimazole treatment of oral candidiasis in patients with neoplastic disease. Am J Med. 1984;76:91–94.
  • Pons V, Greenspan D, Debruin M, et al. Therapy for oropharyngeal candidiasis in HIV-infected patients: A ran-domized, prospective multicenter study of oral fluconazole versus clotrimazole troches. J AIDS. 1993;6:1311–1316.
  • Hughes WT, Bartley DL, Patterson GG, Tufenkeji H. Ketoconazole and candidiasis: A controlled study. J Infect Dis. 1983;147:1060–1063.
  • Como JA, Dismukes WE. Oral azole drugs as systemic antifungal therapy. N Eng J Med. 1994;330:263–272.
  • Fromtling RA. Overview of medically important antifungal azole derivatives. Clin Microbiol Rev. 1988;1:187–217.
  • DeWit S, Weerts D, Goossens H, Clumeck N. Comparison of fluconazole and ketoconazole for oropharyngeal can-didiasis in AIDS. Lancet. 1989;1:746–748.
  • Piscitelli, SC, Flexner C, Minor JR, Polis MA, Masur H. Drug interactions in patients infected with human immuno-deficiency virus. Clin Infect Dis. 1996;23:685–693.
  • Honig PK, Wortham DC, Zamani K, Conner DP, Mullin JC, Cantilena LR. Terfenadine-ketoconazole interaction. Phar-macokinetic and electrocardiographic consequences. JAMA. 1993;269:1513–1518.
  • Meyer JM, Rodvold KA. Drug biotransformation by the cyto-chrome P-450 enzyme system. Infect Med. 1996;June:452–464.
  • Murray PA, Koletar SL, Mallegol I, Wu J, Moskovitz BL. Itraconazole oral solution versus clotrimazole troches for the treatment of oropharyngeal candidiasis in immunocompro-mised patients. Clin Ther. 1997;19:471–480.
  • Hay RJ. Overview of studies of fluconazole in oropharyn-geal candidiasis. Rev Infect Dis. 1990;12\(suppl 3):5334–337.
  • Meunier F, Aoun M, Gerard M. Therapy of oropharyngeal candidiasis in the immunocompromised host: A random-ized double-blind study of fluconazole vs. ketoconazole. Rev Infect Dis. 1990;12\(suppl 3):5364–368.
  • Koletar SL, Russell JA, Fass RJ, Plouffe JF. Comparison of oral fluconazole and clotrimazole troches as treatment for oral candidiasis in patients infected with human immuno-deficiency virus. Antimicrob Agents Chemother. 1990;34:2267–2268.
  • Dupont B, Drouhet E. Fluconazole in the management of oropharyngeal candidosis in a predominantly HIV anti-body-positive group of patients. J Med Vet Mycol. 1988;26:67–71.
  • Zimmermann T, Yeates RA, Laufen H, Pfaff G, Wildfeuer A. Influence of concomitant food intake on the oral absorp-tion of two triazole antifungal agents, itraconazole and fluconazole. Eur J Clin Pharmacol. 1994;46:147–150.
  • Van de Velde VJS, Van Peer AP, Heykants JJP, et al. Effectof food on the pharmacokinetics of a new hydroxypropyl-b-cyclodextrin formulation of itraconazole. Pharmacother. 1996;16:424–428.
  • Barone JA, Moskovitz BL, Guarnieri J, Hassell AE. En-hanced bioavailability of itraconazole in hydroxypropyl-b-cyclodextrin solution compared with capsules in healthy volunteers. Antimicrob Agents Chemother. 1998;42(7)1 862–1865.
  • Graybill JR, Vazquez J, Darouiche RO, et al. Itraconazole oral solution: A novel and effective treatment for oropha-ryngeal candidiasis in HIV/AIDS patients. Am J Med. 1998;104:33–39.
  • Data on file. Janssen Pharmaceutica, Beerse, Belgium.
  • Hostetler JS, Hanson LH, Stevens DA. Effect of cyclodextrin on the pharmacology of antifungal oral azoles. Antimicrob Agents Chemother. 1992;36:477–480.
  • Kowalsky SF, Dixon DM. Fluconazole: A new antifungal agent. Clin Pharm. 1991;10:179–194.
  • Tucker RM, Denning DW, Hanson LH, et al. Interactions of azoles with rifampin, phenytoin, and carbamazepine: In vitro and clinical observations. Clin Infect Dis. 1992;14:165–174.
  • Horsburgh CR Jr, Kirkpatrick CH. Long-term therapy of chronic mucocutaneous candidiasis with ketoconazole: Experience with 21 patients. Am J Med. 1983;74(suppl 1B):23–29.
  • Chavanet P, Lopez J, Grappin M, et al. Cross-sectional study of the susceptibility of Candida isolates to antifungal drugs and in vitro-in vivo correlation in HIV-infected pa-tients. AIDS. 1994;8:945–950.
  • Quereda C, Polanco AM, Giner C, et al. Correlation be-tween in vitro resistance to fluconazole and clinical out-come of oropharyngeal candidiasis in HIV-infected pa-tients. Eur J Clin Microbiol Infect Dis. 1996;15:30–37.
  • Schuman P, Capps L, Peng G, et al. Weekly fluconazole for the prevention of mucosal candidiasis in women with HIV infection. A randomized, double-blind, placebo-con-trolled trial. Ann Intern Med. 1997;126:689–696.
  • Maenza JR, Merz WG, Romagnoli MJ, Keruly JC, Moore RD, Gallant JE. Infection due to fluconazole-resistant Can-dida in patients with AIDS: Prevalence and microbiology. Clin Infect Dis. 1997;24:28–34.
  • Dronda F, Alonso-Sanz M, Laguna F, et al. Mixed oropha-ryngeal candidiasis due to Candida alb/cans and non-alb/cans Candida strains in HIV-infected patients. Eur J Clin Microbiol Infect Dis. 1996;15:446–452.
  • Chryssanthou E, Torssandeer J, Petrini B. Oral Candida alb/ cans isolates with reduced susceptibility to fluconazole in Swedish HIV-infected patients. Scand J Infect Dis. 1995;27:391–395.
  • Tavitian A, Raufman J-P, Rosenthal LE, Weber J, Webber CA, Dincsoy HP. Ketoconazole-resistant Candida esoph-agitis in patients with acquired immunodeficiency syn-drome. Gastroenterol. 1986;90:443–445.
  • Barlett JG. 1998 Medical Management of HIV Infection. Baltimore, MD; Port City Press; 1998.
  • Stevens DA, Greene I, Lang OS. Thrush can be prevented in patients with acquired immunodeficiency syndrome and the acquired immunodeficiency syndrome-related com-plex. Randomized, double-blind, placebo-controlled study of 100-mg oral fluconazole daily. Arch Intern Med. 1991151: 2458–2464.
  • Leen CLS, Dunbar EM, Ellis ME, Mandel BK. Once-weekly fluconazole to prevent recurrence of oropharyngeal candidiasis in patients with AIDS and AIDS-related complex: A double-blind placebo-controlled study. J In-fect. 1990;21:55–60.
  • Powderly WG, Finkelstein DM, Feinberg J, et al. A ran-domized trial comparing fluconazole with clotrimazole tro-ches for the prevention of fungal infections in patients with advanced human immunodeficiency virus infection. N Engl J Med. 1995;332:700–705.
  • Manfredi R, Mastroianni A, Coronado OV, Chiodo F. Fluconazole as prophylaxis against fungal infection in pa-tients with advanced HIV infection. Arch Intern Med. 1997;157:64–69.
  • Moore RD, Chaisson RE. Natural history of opportunistic disease in an HIV-infected urban clinical cohort. Ann Intern Med. 1996;124:633–642.
  • Dupont B, Denning DW, Marriot D, Sugar A, Viviani MA, Sirisanthana T. Mycosis in AIDS. J Med Vet Mycol. 1994;(supp1)32: 65–77.
  • Jensen KB, Stenderup A, Thomsen JB. Esophageal monil-iasis in malignant neoplastic disease. Acta Med Scand. 1964;175:455–459.
  • Kodsi BE, Wickremesinghe PC, Kozinn PJ, Iswam K, Goldberg PK. Candida esophagitis: A prospective study of 27 cases. Gastroenterol. 1976;71:715–719.
  • Scott BB, Jenkins D. Gastro-oesophageal candidiasis. Gut. 1982;23:137–139.
  • Clotet B, Grifol M, Parro B, et al. Asymptomatic esoph-ageal candidiasis in acquired-immunodeficiency-syn-drome-related complex [letter]. Ann Intern Med. 1986;105:145.
  • Ginsburg CH, Braden GL, Tauber Al, Trier JS. Oral clotrimazole in the treatment ofesophageal candidi-asis. Am J Med. 198171: 891–895.
  • Rutgeerts L, Verhaegen H. Intravenous miconazole in the treatment of chronic esophageal candidiasis. Gastroenterol. 1977;72:316–318.
  • Fazio RA, Wickremesinghe PC, Arsura EL. Ketoconazole treatment of Candida esophagitis: A prospective study of 12 cases. Am J Gastroesterol. 1983;78:261–264.
  • Sugar AM, Alsip SG, Galgiani JN, et al. Pharmacology and toxicity of high-doseketoconazole.AntimicrobAgents Chemother. 1987;31:1874–1878.
  • De Wit S, Urbain D, Rahir F, Weerts D, Clumeck N. Efficacy of oral fluconazole in the treatment of AIDS associated oesophageal candidiasis. Eur J Clin Microbiol Infect Dis. 1991;10:503–505.
  • Laine L, Dretler RH, Conteas CN, et al. Fluconazole com-pared with ketoconazole for the treatment of Candida esophagitis in AIDS. A randomized trial. Ann Intern Med. 1992;117:655–660.
  • Laine L, Rabeneck L. Prospective study of fluconazole suspension for the treatment of oesophageal candidiasis in patients with AIDS. Aliment Pharmacol Ther. 1995;9:553–556.
  • Wilcox CM, Darouiche RO, Laine L, Moskovitz BL, Mallegol I, Wu J. A randomized, double-blind compari-son of itraconazole oral solution and fluconazole tablets in the treatment of esophageal candidiasis. J Infect Dis. 1997;176:227–232.
  • Barbaro G, Barbarini G, Di Lorenzo G. Fluconazole com-pared with itraconazole in the treatment of esophageal candidiasis in AIDS patients: A double-blind, random-ized, controlled clinical study. Scand J Infect Dis. 1995;27:613–617.
  • Barbaro G, Barbarini G, Calderon W, Grisorio B, Alcini P, DiLorenzo G. Fluconazole versus itraconazole for Can-dida esophagitis in acquired immunodeficiency syn-drome. Gastroenterol. 1996;111:1169–1177.
  • Medoff G, Dismukes WE, Meade RH III, Moses JM. A new therapeutic approach to Candida infections. A pre-liminary report. Arch Intern Med. 1972;130:241–245.
  • Bennett JE. Diagnosis and management of candidiasis inthe immunosuppressed host. Scand J Infect Dis. 1978;(supp1)16: 83–86.
  • Lake DE, Kunzweiler J, Beer M, Buell DN, Islam MZ. Fluconazole versus amphotericin B in the treatment of esophageal candidiasis in cancer patients. Chemother. 1996;42:308–314.
  • Barbaro G, Barbarini G, Di Lorenzo G. Fluconazole vs. flucytosine in the treatment of esophageal candidiasis in AIDS patients: A double-blind, placebo controlled study. Endoscopy. 1995;27:377–383.
  • Reef SE, Mayer KH. Opportunistic candidal infections in patients infected with human immunodeficiency virus: Prevention issues and priorities. Clin Infect Dis. 1995;21\(suppl 1):599–102.
  • Koletar SL, Weed HG, Raimundo MB. Thrush unrespon-sive to treatment with fluconazole in HIV-infected pa-tients. Presented at: First National Conference on Hu-man Retroviruses; January 1994; Washington, DC. Abstract 61.
  • Vazquez JA, Sobel JD. Epidemiologic overview of resis-tance to oral antifungal agents in the immunocompromised host [abstract]. Excerpta Med/ca. 1997;1–11.
  • National Committee for Clinical Laboratory Standards. Reference Method for Broth Dilution Ant/fungal Suscep-tibility Testing of Yeasts: Approved Standard. Wayne, PA: National Committee for Clinical Laboratory Stan-dards; 1997. NCCLS document M27–A.
  • Rex JH, Pfaller MA, Galgiani JN, et al. Development of interpretive breakpoints for antifungal susceptibility test-ing: Conceptual framework and analysis of in-vitro corre-lation data for fluconazole, itraconazole, and Candida infections. Clin Infect Dis. 1997;24:235–247.
  • Cameron ML, Schell WA, Bruch S, Bartlett JA, Waskin HA, Perfect JR. Correlation of in vitro fluconazole resis-tance of Candida isolates in relation to therapy and symptoms of individuals seropositive for human immu-nodeficiency virus type 1. Antimicrob Agents Chemother. 1993;37:2449–2453.
  • Revankar SG, Dib OP, Kirkpatrick WR, et al. Clinical evaluation and microbiology of oropharyngeal infection due to fluconazole-resistant Candida in human immuno-deficiency virus-infected patients. Clin Infect Dis. 1998;26:960–963.
  • Fox R, Neal KR, Leen CLS, Ellis ME, Mandal BK. Fluconazole-resistant Candida in AIDS [letter]. J Infect Dis. 1991;22:201–204.
  • Kitchen VS, Savage M, Harris JR. Candida alb/cans re-sistance in AIDS [letter]. J Infect Dis. 199122: 204–205.
  • Horn CA, Washburn RG, Givner LB, Peacock JE Jr, Pegram PS. Azole-resistant oropharyngeal and esoph-ageal candidiasis in patients with AIDS. AIDS. 1995;9:533–534.
  • Maenza JR, Keruly JC, Moore RD, Chaisson RE, Merz WG, Gallant JE. Risk factors for fluconazole-resistant candidiasis in human immunodeficiency virus-infected patients. J Infect Dis. 1996;173:219–225.
  • McCarthy GM, Mackie ID, Koval J, Sandhu HS, Daley TD. Factors associated with increased frequency of HIV-related oral candidiasis. J Oral Pathol Med. 199120: 332–336.
  • Martins M, Rex JH. Fluconazole suspension for oropha-ryngeal candidiasis unresponsive to tablets [letter]. Ann Intern Med. 1997;126:332–333.
  • Parving H. Fluconazole suspension for oropharyngeal candidiasis unresponsive to tablets. Ann Intern Med. 1997;126:332–333.
  • St.-Germain G, Dion C, Espinel-Ingroff A, RateIle J, de Repentigny L. Ketoconazole and itraconazole suscepti-bility of Candida alb/cans isolated from patients infected with HIV. J Antimicrob Chemother. 1995;36:109–118.
  • Philips P, Zemcov J, Mahmood W, Montaner JSG, Craib K, Clarke AM. Itraconazole cyclodextrin solution for fluconazole-refractory oropharyngeal candidiasis in AIDS: Correlation of clinical response with in vitro sus-ceptibility. AIDS. 1996;10:1369–1376.
  • Eichel M, Just-Nübling G, Helm EB, Stille W. Itraconazole suspension in the treatment of HIV-infected patients with fluconazole-resistant oropharyngeal can-didiasis and esophagitis. Mycoses. 1996;39\(suppl 1):102–106.
  • Fessel WJ, Merrill KW, Ward DJ, et al. Itraconazole oral solution for the treatment of fluconazole-refractory oropharyngeal candidiasis in HIV-positive patients. In: Proceedings of the Fourth Annual Conference on Retroviral Opportunistic Infections; February 1997; Chi-cago. Abstract 124.
  • Cartledge JD, Midgley J, Gazzard BG. Itraconazole cyclodextrin solution: The role of in vitro susceptibility testing in predicting successful treatment of HIV-related fluconazole-resistant and fluconazole-susceptible oral candidosis. AIDS. 1997;11:163–168.
  • Coppola S, Angarano G, Montagna MT, et al. Efficacy of itraconazole in treating AIDS-associated infections due to Candida krusei. Eur J Epidemiol. 1995;11:243–244.
  • de Repentigny L, Ratelle J, and the Human Immunodefi-ciency Virus Itraconazole-Ketoconazole Project Group. Comparison of itraconazole and ketoconazole in HIV-positive patients with oropharyngeal or esophageal can-didiasis. Chemother. 1996;42:374–383.
  • Nguyen MT, Weiss PJ, LaBarre RC, Miller LK, Oldfield EC, Wallace MR. Orally administered amphotericin B in the treatment of oral candidiasis in HIV-infected patients caused by azole-resistant Candida albicans. AIDS. 1996;10:1745–1747.
  • Dewsnup, DH, Stevens DA. Efficacy of oral amphotericin B in AIDS patients with thrush clinically resistant to fluconazole. J Med Vet Mycol. 1994;32:389–393.
  • Zingman BS. Treatment of mucosal candidiasis in HIV-infected patients. J Mycol Med. 1996;6:3–11.
  • Brajtburg J, Powderly WG, Kobayashi GS, Medoff G. Amphotericin B delivery systems. Antimicrob Agents Chemother. 1990;34:381–384.
  • Ruhnke M, Schmidt-Westhausen A, Trautmann M. In vitro activities of voriconazole (UK-109,496) against fluconazole-susceptible and -resistant Candida albicans isolates from oral cavities of patients with human immu-nodeficiency virus infection. Antimicrob Agents Chemother. 1997;41:575–577.
  • Law D, Denning DW. In vitro activity of Schering 56592, compared with fluconazole and itraconazole against Candida spp. In: Proc 36th Int Conf Antimicrob Agents Chemother; September 1996; New Orleans, LA. Ab-stract 115.
  • Vazquez J, Lynch M, Boikov D, Sobel JD. In vitro activity of a new pneumocandin antifungal, L-743,872, against azole-susceptible and -resistant Candida species. Antimicrob Agents Chemother. 1997;41:1612–1614.
  • Zingman B. Resolution of refractory AIDS-related mu-cosal candidiasis after initiation of didanosine plus saquinavir [letter]. N Engl J Med. 1996;334:1674–1675.
  • Vecchiarelli A, Monari C, Baldelli F, et al. Beneficial effect of recombinant human granulocyte colony-stimulating factor on fungicidal activity of polymorphonuclear leuko-cytes from patients with AIDS. J Infect Dis. 1995;171:1448–1454.
  • Bonfati P, Capetti A, De Micheli A, Milella AM, Rizzardini G. HuGM-CSF employment for resistant Candida infec-tions in HIV disease. Presented at: XI International Con-ference on AIDS; July 1996; Vancouver, B.C., Canada. Abstract 286.
  • Swindells S, Kleinschmidt DR, Hayes FA. Pilot study of adjunctive GM-CSF (yeast-derived) for fluconazole-re-sistant oral candidiasis in HIV-infection. Infect Dis Clin Pract. 1997;6:278–279.
  • Vazquez JA, Gupta S, Villanueva A. Role of rhu-GM-CSF as adjunctive treatment of antifungal refractory oropha-ryngeal candidiasis in patients with AIDS. Eur J Clin Microbiol Infect Dis. 1998;17:781–783.
  • Vazquez JA, Vaishampayan J, Arganoza MT, Richards S, Boikov D, Sobel JD. Use of an over the counter product, Breathaway (melaleuca oral solution), as an alternative agent for refractory oropharyngeal candidiasis in AIDS patients. AIDS. 1998;12:1033–1037.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.