[Assessment of in vitro activity and stability of antifungal suspensions for mouthrinses: to a reappraisal of empiric practices?]. / Étude d'activité in vitro et de stabilité de suspensions antifongiques pour bain de bouche : vers une remise en question de pratiques empiriques ?

Establishment of an effective prophylaxis against oral candidiasis by local treatment is essential for immunocompromised patients. The aim of the study is to assess effectiveness and stability of antifungal suspensions for mouthrinses. The assessed suspensions are compounded by one solvent among sterile water, spring water or sodium bicarbonate associated with amphotericin B (Fungizone®) or nystatine (Mycostatine®). Two others mixes are assessed: Mycostatine®-bicarbonate and Mycostatine®-Hextril®-bicarbonate as well as the two straight antifungal. In vitro activity is tested on five Candida species (C. albicans, C. glabrata, C. krusei, C. parapsilosis, C. tropicalis) after a five minutes contact between yeasts and the assessed suspension. A galenic study is realized during 3 days. Mixes associating a polyene with sodium bicarbonate have no effectiveness on Candida albicans, others mixes shows intermediate effectiveness (the percentage of yeast growth inhibition lies between 35% and 68%). Effectiveness results of Hextril®-based mixes are not explainable because of alcohol in its composition. Spring water-based mixes must be evicted due to microbiologic contaminations after 48hours. Mycostatine®-Hextril®-bicarbonate mix is not stable during 3 days. All those mouthrinses, poorly effective, excepted on C. glabrata, should be avoided. Straight Mycostatine® shows a good antifungal effectiveness excepted on C. krusei and its use should be recommended.

[Prophylaxis use of posaconazole (P) in an hemato-oncology unit: a retrospective study]. / Le posaconazole (P) utilisé en prophylaxie dans un service d'hémato-oncologie : une étude rétrospective.

UNLABELLED: OBJECTIVE OF THIS STUDY: The mortality level of leucemic patient's fungal infections can reach 70%. Antifungal prophylaxis posaconazole (P) is used during severe and prolonged neutropenia resulting from chemotherapy for acute myelogenous leukemia (AML), myelodysplastic syndrome and after autologous transplant. PATIENTS AND METHODS: We realized a retrospective study in order to assess the efficiency of P. Oral prophylaxy dosage is 200mg every eight hours to beginning before presumed neutropenia. Treatment failure was defined as the occurrence of proven/probable invasive fungal infections (IFI), receipt of any other systemic antifungal agent for suspected IFI or for impossible swallowing and the occurrence of adverse event. The objective is to note down the incidence of proven/probable IFI prevented by P. RESULTS: We included 22 patients of whom 86% suffered from AML. P was prescribed in IFI prophylaxies during prolonged and severe neutropenia postchemotherapy (72%) or postautologous transplant (28%) and initiated 7 days before neutropenia (50% of cases). The mean treatment period was 18 days. Colonization occurred in one third of patients (43% of Candida albicans). Esomeprazole (E) 40 mg was associated in 64% of cases. P prophylaxis failed in 50% of cases. Proven/probable IFI occurred in one case. Different failure causes were: suspected or possible IFI (n=5) and impossible swallowing (n=5). CONCLUSION: P prophylaxis seems to be efficient among these high-risk patients. However, a P tardive initiation, an E association, P administration and resorption difficulties seem to have a importance in successful treatment. It would be interesting to optimize P treatment with plasmatic dosages to ensure efficiency and safety for patients.