Case 4: Fluconazole-Resistant Oropharyngeal Candidiasis

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You answered:

	The most important risk factor identified for the development of fluconazole-resistant oropharyngeal candidiasis is the use of trimethoprim-sulfamethoxazole for longer than 60 days.

This answer is incorrect. Although some antimicrobials increase the risk of patients developing oral candidiasis, there are no data to suggest trimethoprim-sulfamethoxazole use is directly related to the development of fluconazole-resistant candidiasis.

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	Fluconazole exerts its effect by inhibiting fungal cell wall synthesis. Fluconazole resistance in Candida species occurs primarily through an increase production in cell wall precursors.
	More than 95% of Candida albicans isolates from patients with fluconazole-refractory oropharyngeal candidiasis show resistance to itraconazole (Sporanox). Fewer than 5% of patients with fluconazole-refractory oropharyngeal candidiasis will respond to itraconazole solution at a dose of 200 mg per day.
	Major identified risk factors for the development of fluconazole-resistant candidiasis include low CD4 cell count and cumulative fluconazole use.

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