AIDS TREATMENT NEWS No. 058 - June 3, 1988
John S. James
The only drawback is that because of red tape, fluconazole is hard to get in the United States. Pfizer Inc., the manufacturer, does supply it for cryptococcal meningitis and certain other conditions when all approved treatments have failed. But in practice many physicians do not know about fluconazole or how to get it, and many patients--perhaps most-- who should get the drug, die instead.
In Europe fluconazole is much more available, and thousands of people have used it, even for much less serious conditions such as skin or vaginal yeast infections. But in the U.S. there is a widespread official belief that compassionate-use drugs should not be widely available to persons with AIDS. Various excuses are used, various obstacles are allowed to block treatment access.
Part of the problem is that little has been published on fluconazole. We only know of two case reports in the medical literature of fluconazole used for AIDS-related cryptococcal meningitis. One, published by physicians at the Pasteur Institute (Annals of Internal Medicine, May 1987) was cited in our earlier report (AIDS Treatment News #41).
The other, the occasion for this article, appeared in the March 1988 Annals of Internal Medicine (Byrne, WR, and Wajszczuk, CP. Cryptococcal Meningitis in the Acquired Immunodeficiency Syndrome (AIDS): Successful Treatment With Fluconazole After Failure Of Amphotericin B. Volume 108, number 3, pages 384-385.) Fluconazole was used after amphotericin B and other treatments became ineffective; the amphotericin had been used for 15 months. Two weeks after the change to fluconazole, improvement was "dramatic"; and the cerebrospinal fluid culture became negative for the first time in a year, and stayed negative. The patient has done well at home on fluconazole for a year. There have been no side effects.
For medical information about fluconazole and how to obtain it, physicians only should call Pfizer Central Research, Groton, Connecticut, (203) 441-4112.
Readers can help to make fluconazole and other drugs more available by lobbying AIDS organizations--or gay, medical, or other organizations--to educate themselves and appoint a person or committee to work to overcome the red tape, ignorance, inertia, mismanagement, and commercialism blocking the research which should be done and the drugs which should be accessible to physicians and patients. Waiting for the system to move at its own pace will result in thousands of unnecessary deaths. The major AIDS organizations, fearing controversy and loss of funding, have so thoroughly ignored this issue that even a little effort will go a long way.
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