Controlled trial of arbaprostil in bleeding peptic ulcer.

TLDR: Treatment with ketoconazole resulted in the virtual elimination of the outbreak strain, the incidence of cases returning to its former value, with occasional cases caused by the patients' own yeast flora.

Abstract: Oral ketoconazole appreciably reduced the rate of isolation of the outbreak strain from both systemically infected and colonised patients. The outbreak strain did not reappear when ketoconazole was withdrawn. All cases of systemic candidiasis acquired in the unit before April 1984 were caused by the outbreak strain, whereas after May 1984 all cases were caused by other strains. Control of an outbreak depends on its identification and the prevention of cross infection. Existing handwashing reagents can be replaced with fungicidal disinfectants such as Hibisol or Betadine, and antifungal prophylaxis can be given. Recent work in neutropenic patients in whom infection was probably due to an endogenous isolate showed that ketoconazole was as effective as amphotericin B, and prophylaxis with either agent failed.5 In this study ketoconazole failed in six cases, perhaps because of poor absorption in the gut as five patients had undergone major gastrointestinal surgery. Treatment with ketoconazole resulted in the virtual elimination of the outbreak strain, the incidence of cases returning to its former value, with occasional cases caused by the patients' own yeast flora. A much shorter course of prophylaxis might have been equally effective and could be considered in any unit where the incidence of candidal sepsis is unacceptably high and cross infection a problem.