Esophageal candidiasis medical therapy: Difference between revisions
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{{CMG}};{{AE}}{{AY}} | {{CMG}};{{AE}}{{AY}} | ||
==Overview== | ==Overview== | ||
Esophageal candidiasis is almost always treated with [[Antifungals|systemic antifungals]] (either parentral or oral). A trial of [[Antifungal|antifungal therapy]] is done before performing [[endoscopy]] in [[HIV]] patients with [[esophagitis]]. | |||
==Medical therapy== | ==Medical therapy== | ||
*Esophageal candidiasis is almost always treated with systemic antifungals (either parentral or oral) | *Esophageal candidiasis is almost always treated with [[Antifungals|systemic antifungals]] (either parentral or oral).<ref name="pmid26679628">{{cite journal |vauthors=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 |title=Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America |journal=Clin. Infect. Dis. |volume=62 |issue=4 |pages=e1–50 |year=2016 |pmid=26679628 |pmc=4725385 |doi=10.1093/cid/civ933 |url=}}</ref> | ||
*A | *A trial of [[Antifungal|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:=== | ===First line antifungal therapy:=== | ||
*Oral fluconazole: 200-400 mg | *Oral [[fluconazole]]: 200-400 mg for 14-21 days | ||
*IV fluconazole: 400 mg daily (6mg/kg/day) | *IV [[fluconazole]]: 400 mg daily (6mg/kg/day) | ||
*Amphotericin B deoxycholate (AmB-d): 0.3-0.7 mg/day | *[[Amphotericin B|Amphotericin B deoxycholate (AmB-d)]]: 0.3-0.7 mg/day | ||
===In fluconazole refractory patients:=== | ===In fluconazole refractory patients:=== | ||
*Itraconazole: 200 mg daily | *[[Itraconazole]]: 200 mg daily | ||
*Voriconazole: 200 mg twice daily for 14-21 days | *[[Voriconazole]]: 200 mg twice daily for 14-21 days | ||
*Micafungin: 150 mg daily | *[[Micafungin]]: 150 mg daily | ||
*Caspofungin: 50 mg daily | *[[Caspofungin]]: 50 mg daily | ||
*Anidu-lafungin: 200 mg daily | *Anidu-lafungin: 200 mg daily | ||
*AmB-d: 0.3 - 0.7 mg/kg daily | *[[Amphotericin B|AmB-d:]] 0.3 - 0.7 mg/kg daily | ||
===Prophylactic (suppressive) therapy:=== | ===Prophylactic (suppressive) therapy:=== | ||
*Fluconazole 100-200 mg 3 times/ week | *[[Fluconazole]] 100-200 mg 3 times/ week | ||
===HIV patients:=== | ===HIV patients:=== | ||
*Highly active antiretroviral theapy (HAART) decreases recurrence of candida esophagitis. | *[[HIV AIDS medical therapy|Highly active antiretroviral theapy (HAART)]] decreases recurrence of candida esophagitis. | ||
=== Supportive therapy in patients with severe odynophagia: === | |||
==== Nutritional support: ==== | |||
* [[IV fluids]] or [[TPN|total parentral nutrition]]. | |||
* Gastric tube feeding | |||
==== Symptomatic treatment: ==== | |||
* [[Analgesics]] in the form of [[NSAIDs]] or [[morphia]]. | |||
* [[Calcium channel blocker|Calcium channel blockers]] to avoid spasms in response to the pain. | |||
==References== | ==References== | ||
{{Reflist|2}} | |||
[[Category:Emergency medicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Otolaryngology]] | |||
[[Category:Immunology]] | |||
Latest revision as of 21:40, 29 July 2020
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Esophageal candidiasis medical therapy On the Web |
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Risk calculators and risk factors for 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.