Candidiasis

Oropharyngeal Candidiasis

Diagnosis: typical clinical appearance, see Drug-drug Interactions Between ARVs and Non-ARVs, for all azole therapies

  Drug / Dose Comments
Preferred alternatives   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

Oesophagitis

Definitive diagnosis: macroscopic inspection at endoscopy, OR histology of biopsy, OR cytology of specimen from the mucosal surface 

Presumptive diagnosis: if recent onset of dysphagia AND oropharyngeal candidiasis

  Drug / Dose Comments
Preferred alternatives  fluconazole
400 mg qd for 3 days
or 400 mg loading dose, then
200 mg qd po for 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