Esophageal candidiasis medical therapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]
Overview
Esophageal candidiasis is almost always treated with systemic antifungals (either parentral or oral). A trial of antifungal therapy is done before performing endoscopy in HIV patients with esophagitis.
Medical therapy
- Esophageal candidiasis is almost always treated with systemic antifungals (either parentral or oral).[1]
- A trial of antifungal therapy is done before performing endoscopy in HIV patients with esophagitis (because candida esophagitis is the most common cause of infectious esophagitis). If no improvement within 5-7 days, then endoscopy is indicated.
First line antifungal therapy:
- Oral fluconazole: 200-400 mg for 14-21 days
- IV fluconazole: 400 mg daily (6mg/kg/day)
- Amphotericin B deoxycholate (AmB-d): 0.3-0.7 mg/day
In fluconazole refractory patients:
- Itraconazole: 200 mg daily
- Voriconazole: 200 mg twice daily for 14-21 days
- Micafungin: 150 mg daily
- Caspofungin: 50 mg daily
- Anidu-lafungin: 200 mg daily
- AmB-d: 0.3 – 0.7 mg/kg daily
Prophylactic (suppressive) therapy:
- Fluconazole 100-200 mg 3 times/ week
HIV patients:
- Highly active antiretroviral theapy (HAART) decreases recurrence of candida esophagitis.
Supportive therapy in patients with severe odynophagia:
Nutritional support:
- IV fluids or total parentral nutrition.
- Gastric tube feeding
Symptomatic treatment:
- Analgesics in the form of NSAIDs or morphia.
- Calcium channel blockers to avoid spasms in response to the pain.
References
- ↑ Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD (2016). “Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America”. Clin. Infect. Dis. 62 (4): e1–50. doi:10.1093/cid/civ933. PMC 4725385. PMID 26679628.
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