Esophageal candidiasis medical therapy

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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).
• 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.