AUTO BREWERY CAN EASE WITH DIET AND ANTIFUNGALS
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OKAY BACK FROM THE PHARMACY 💊
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THE TRANSPLANT PATIENT WHO RELAPSED 🔁
A Cohort Study Of Auto Brewery Patients Reported One Transplant
It Was A Fecal Microbiota Transplantation Or FMT
The Patient Had Already Tried Antifungal Therapy
He Had Also Almost Entirely Removed Carbohydrates From His Diet
The Authors Say Those Approaches Failed To Durably Suppress His Flares
A Review Board And The FDA Approved Single Patient Expanded Access
He Took Oral Antibiotics Before The Transplant Capsules
Next Came 5 Doses Of 15 Capsules Over A Week
The Capsules Were Generated From A Healthy Unrelated Donor
He Did Well For 3 Months With No Intoxication Flares
The Paper Reports No Detectable Blood Alcohol For 3 Months
Relapse Followed That Initial Period Of Remission
During A Flare His Gut Microbes Shifted Back Toward Their Old Makeup
A Second Transplant Came Nine Months After The First
It Followed A More Aggressive Antibacterial Pretreatment Regimen
Monthly Maintenance Doses Of FMT Lasted 6 Months
He Stayed In Remission For Over 16 Months After The Second
His Diet Then Advanced To Include More Complex Carbohydrates
The Authors Call This The Successful Treatment Of One Patient
Treatment Was Associated With Fewer Proteobacteria
The Authors Hold Bacteria Not Fungi Responsible In Most Patients
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WHAT ANTIFUNGALS AND DIET DID IN CASE REPORTS 🍄
A Systematic Review Lists Antifungals Among Current Treatments
It Also Lists Low Carbohydrate Diet And Antibiotics And Probiotics
In Five Case Reports Fluconazole Or Diet Or Both Was Sufficient
Some Patients Needed A Switch Because Fluconazole Was Ineffective
The Other Drugs Included Nystatin And Amphotericin And Micafungin
Case Reports Describe What Happened With Fluconazole
One Report Describes A 25 Year Old Man
He Took Fluconazole Daily For 3 Weeks
His Normal Diet Continued Alongside It
Complete Resolution Of His Symptoms Followed
Another Describes A 52 Year Old Man
He Was Placed On A Strict Low Carbohydrate Diet
Daily Fluconazole Was Part Of His Treatment Too
The Treatment Eased His Episodes In Both Frequency And Severity
His Symptoms Became More Frequent As Fluconazole Was Tapered
Episodes Occurred Once Or Twice Per Week After The Taper
Daily Fluconazole Was Restarted With Plans For At Least 3 Months
He Was Also Referred To A Dietitian For A Very Low Carbohydrate Diet
A Third Describes A 45 Year Old Man
He Still Tested Positive On A Higher Antifungal Dose
Doctors Then Changed His Fluconazole To Intravenous Micafungin
Once Micafungin Started Every Reading Became Undetectable
The Micafungin Continued For Eight Weeks
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WHAT TREATMENT EVIDENCE EXISTS TODAY 🌅
One Case Report Says The Antifungal Of Choice Is Not Currently Known
It Adds That This Is Particularly So For Saccharomyces
Its Authors Name The Main Benefit Of Culturing The Organism
A Culture Shows Which Antifungals The Organism Is Sensitive To
The Review Calls Treating By Sensitivity Testing More Ideal
It Also Notes A Fecal Transplant Might Have A Potential Role
A Registered Trial Is Studying Transplant Capsules In Auto Brewery
Its Main Question Is Whether The Transplant Is Safe And Feasible
Registry Text Calls It A Pilot Safety And Feasibility Study
Its Planned Enrollment Is 8 People
Participants Are Followed For 6 Months For Safety
Its Status Is Active Not Recruiting
Adequate Dosing Is Among Its Measured Outcomes
The Registry Lists No Results For The Trial Yet
All Of The Review's Studies Were Case Reports
In Auto Brewery Gut Or Urinary Tract Microbes Make Alcohol
A Supervised Carbohydrate Test May Reveal The Condition
The Transplant Patient Relapsed Before His Second Transplant
That Cohort Study Says There Is Currently No Consensus
Its Authors Add That No Standard Therapy Exists Yet
