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Management
XVI. Oropharyngeal Candidiasis
Î For mild disease, clotrimazole troches, 10 mg 5 times daily, OR
miconazole mucoadhesive buccal 50 mg tablet applied to the
mucosal surface over the canine fossa once daily for 7-14 days are
recommended (S/H).
Î Alternatives for mild disease include nystatin suspension, (100,000 U/mL)
4-6 mL 4 times daily, OR 1-2 nystatin pastilles, (200,000 U each) 4 times
daily, for 7-14 days (S/M).
Î For moderate to severe disease, oral fluconazole, 100-200 mg daily,
for 7-14 days is recommended (S/H).
Î For fluconazole-refractory disease, itraconazole solution, 200 mg once
daily OR posaconazole suspension, 400 mg twice daily for 3 days then
400 mg daily, for ≤28 days is recommended (S/M).
Î Alternatives for fluconazole-refractory disease include voriconazole,
200 mg twice daily, OR AmB deoxycholate oral suspension, 100 mg/mL
4 times daily (S/M).
Î Intravenous echinocandin (caspofungin, 70 mg loading dose,
then 50 mg daily, micafungin 100 mg daily, or anidulafungin, 200 mg
loading dose, then 100 mg daily) OR intravenous AmB deoxycholate,
0.3 mg/kg daily, are other alternatives for refractory disease (W/M).
Î Chronic suppressive therapy is usually unnecessary. If required for
patients who have recurrent infection, fluconazole, 100 mg 3 times
weekly, is recommended (S/H).
Î For HIV-infected patients, antiretroviral therapy is strongly
recommended to reduce the incidence of recurrent infections (S/H).
Î For denture-related candidiasis, disinfection of the denture, in
addition to antifungal therapy, is recommended (S/M).
XVII. Esophageal Candidiasis
Î Systemic antifungal therapy is always required. A diagnostic trial of
antifungal therapy is appropriate before performing an endoscopic
examination (S/H).
Î Oral fluconazole, 200-400 mg (3-6 mg/kg) daily, for 14-21 days is
recommended (S/H).
Î For patients who cannot tolerate oral therapy: Intravenous fluconazole,
400 mg (6 mg/kg) daily, OR an echinocandin (micafungin, 150 mg
daily, caspofungin, 70 mg loading dose, then 50 mg daily, or
anidulafungin, 200 mg daily) is recommended (S/H).
