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Candidiasis
Diagnosis and treatment
Diagnosis:
- Oropharyngeal candidiasis: typical clinical appearance
- Oesophagitis:
- definitive diagnosis: evidence of disease at macroscopic inspection during endoscopy, OR histology of biopsy, OR cytology of specimen from the mucosal surface
- presumptive diagnosis: recent onset of dysphagia AND oropharyngeal candidiasis
Notes on treatment:
see Drug-drug Interactions Between ARVs and Non-ARVs and Anti-infective/ART interaction table for all azole therapies
Oropharyngeal candidiasis
| Drug / Dose | Comments |
|---|---|
| fluconazole 150-200 mg qd po |
Once or until improvement (5-7 days) |
| nystatin 3-6 lozenges at 400000 units (aprox. 4-6 mL of oral suspension)/day |
7-14 days |
| OR amphotericin B oral suspension 1-2 g bid - qid |
7-14 days |
Esophagitis
| Drug / Dose | Comments |
|---|---|
| fluconazole 400 mg qd po OR 400 mg loading dose, then 200 mg qd po |
3 days 10-14 days |
| consider posaconazole 400 mg bid po OR voriconazole 200 mg bid po OR caspofungin and other echinocandins 70 mg iv qd day 1, then 50 mg qd |
In cases of refractory disease, treat according to resistance testing. Adapt posaconazole and voriconazole dose according to MIC's of candida and drug trough levels |