Version May 2024
| Condition | Initial therapy | Alternatives for refractory disease* | Duration |
| Oropharyngeal | Mild:¶
Moderate to severe or unresponsive to topical treatment:
| Initial approach:
If no response after several days, switch to alternative agent:
| Duration of treatment is 7 to 14 days for uncomplicated disease. For refractory disease, the duration is usually extended to 14 to 28 days. |
| Esophageal | Preferred (regardless of disease severity):
Alternatives for initial therapy:◊
| Initial approach:
If no response after several days, switch to alternative agent:
| Duration of therapy is 14 to 21 days for initial treatment. For refractory disease, the duration is extended to 28 days. |
IV: intravenous.
* Additional evaluation (eg, resistance testing) may be needed for patients with refractory disease.
¶ For most patients with mild disease, we prefer topical therapy; clotrimazole troches or miconazole mucoadhesive buccal tablets appear to be more effective than nystatin. However, oral fluconazole (200 mg loading dose, followed by 100 to 200 mg daily for 7 to 14 days) can be used for initial therapy if a patient cannot use troches or suspension because of the possibility of aspiration or being unable to follow directions or is at risk for disseminated disease due to severe mucosal breakdown.
Δ Fluconazole is generally the preferred treatment for moderate to severe oropharyngeal disease and esophageal disease. Although other oral azoles (eg, itraconazole oral solution, posaconazole suspension, voriconazole) are also effective for initial therapy, we prefer fluconazole due its ease of administration, low side effect profile, low risk of drug interactions, and cost.
◊ On rare occasion, when a patient has infection due to Candida glabrata or Candida krusei, fluconazole is typically not effective, and treatment with an alternative agent is required.
§ Amphotericin B deoxycholate oral suspension is not a commercially available product in the United States. The dose is 500 mg of an extemporaneously compounded 100 mg/mL suspension 3 to 4 times daily.[2] Patients should swish in the mouth and retain for as long as possible (several minutes) before swallowing.
¥ Our preferred dosing of echinocandins in adults with esophagitis is as follows: anidulafungin 200 mg IV daily; caspofungin 70 mg daily; or micafungin 150 mg IV daily. These doses are higher than those used for candidemia since there are higher rates of relapse with echinocandins than with azoles when used for the treatment of Candida esophagitis. However, some experts use lower doses of anidulafungin and caspofungin.[3]
‡ Lipid formulations of amphotericin are generally preferred over the deoxycholate formulation because the risk of toxicity is reduced. However, if lipid formulations are not available and amphotericin B deoxycholate is used, the dose is 0.3 to 0.7 mg/kg IV daily.
† There is no standard dosing of isavuconazole for treatment of Candida esophagitis; oral options include: 744 mg isavuconazonium orally as a single dose, then 186 mg isavuconazonium orally once daily or 744 mg isavuconazonium orally once weekly.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
