Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point of care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

For more information, click below.


Subscribers log in here


Treatment of oropharyngeal and esophageal candidiasis

INTRODUCTION

Candida species can be associated with infections involving mucosal membranes, including the oropharynx and esophagus. The majority of these infections are related to Candida albicans. Oropharyngeal infection is often asymptomatic unless it is associated with lower tract disease, which is usually characterized by dysphagia or odynophagia.

The treatment of oropharyngeal candidiasis or esophageal candidiasis will be discussed below. The clinical manifestations of oropharyngeal and esophageal candidiasis are discussed elsewhere. (See "Clinical manifestations of oropharyngeal and esophageal candidiasis" and "Evaluation of the HIV-infected patient with odynophagia and dysphagia" and "Overview of Candida infections".)

OROPHARYNGEAL CANDIDIASIS

The preferred therapy for the treatment of oropharyngeal candidiasis differs by patient population. The general duration of treatment is 7 to 14 days [1]. For any given drug, not all individuals with a clinical response will achieve a mycological response; however rates of relapse within one month tend to be lower when a mycological cure is obtained.

Considerations for treatment choice include drug effectiveness, severity of infection, ease of administration, anticipated adherence, gastric acidity (which may affect absorption), drug-drug interactions, and cost.

HIV-seronegative patients — The treatment of oropharyngeal candidiasis in patients without AIDS is usually accomplished with local antifungal lozenges or solutions [1-3].

                           

Subscribers log in here

To continue reading this article you must have access through your hospital or your group practice, log in to your personal subscription, or purchase a personal subscription. For more information, click below.
Literature review current through: Apr 2013. | This topic last updated: Aug 6, 2012.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2013 UpToDate, Inc.
References
Top
  1. Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:503.
  2. Darouiche RO. Oropharyngeal and esophageal candidiasis in immunocompromised patients: treatment issues. Clin Infect Dis 1998; 26:259.
  3. Shay K, Truhlar MR, Renner RP. Oropharyngeal candidosis in the older patient. J Am Geriatr Soc 1997; 45:863.
  4. Klotz SA. Oropharyngeal candidiasis: a new treatment option. Clin Infect Dis 2006; 42:1187.
  5. Patton LL, Bonito AJ, Shugars DA. A systematic review of the effectiveness of antifungal drugs for the prevention and treatment of oropharyngeal candidiasis in HIV-positive patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 92:170.
  6. Koletar SL, Russell JA, Fass RJ, Plouffe JF. Comparison of oral fluconazole and clotrimazole troches as treatment for oral candidiasis in patients infected with human immunodeficiency virus. Antimicrob Agents Chemother 1990; 34:2267.
  7. Sangeorzan JA, Bradley SF, He X, et al. Epidemiology of oral candidiasis in HIV-infected patients: colonization, infection, treatment, and emergence of fluconazole resistance. Am J Med 1994; 97:339.
  8. Finlay PM, Richardson MD, Robertson AG. A comparative study of the efficacy of fluconazole and amphotericin B in the treatment of oropharyngeal candidosis in patients undergoing radiotherapy for head and neck tumours. Br J Oral Maxillofac Surg 1996; 34:23.
  9. Oude Lashof AM, De Bock R, Herbrecht R, et al. An open multicentre comparative study of the efficacy, safety and tolerance of fluconazole and itraconazole in the treatment of cancer patients with oropharyngeal candidiasis. Eur J Cancer 2004; 40:1314.
  10. Iacopino AM, Wathen WF. Oral candidal infection and denture stomatitis: a comprehensive review. J Am Dent Assoc 1992; 123:46.
  11. Redding SW, Dahiya MC, Kirkpatrick WR, et al. Candida glabrata is an emerging cause of oropharyngeal candidiasis in patients receiving radiation for head and neck cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97:47.
  12. Redding SW, Kirkpatrick WR, Coco BJ, et al. Candida glabrata oropharyngeal candidiasis in patients receiving radiation treatment for head and neck cancer. J Clin Microbiol 2002; 40:1879.
  13. Klein RS, Harris CA, Small CB, et al. Oral candidiasis in high-risk patients as the initial manifestation of the acquired immunodeficiency syndrome. N Engl J Med 1984; 311:354.
  14. Moore RD, Chaisson RE. Natural history of opportunistic disease in an HIV-infected urban clinical cohort. Ann Intern Med 1996; 124:633.
  15. MacPhail LA, Hilton JF, Dodd CL, Greenspan D. Prophylaxis with nystatin pastilles for HIV-associated oral candidiasis. J Acquir Immune Defic Syndr Hum Retrovirol 1996; 12:470.
  16. Kaplan JE, Benson C, Holmes KH, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep 2009; 58:1.
  17. Pons V, Greenspan D, Debruin M. Therapy for oropharyngeal candidiasis in HIV-infected patients: a randomized, prospective multicenter study of oral fluconazole versus clotrimazole troches. The Multicenter Study Group. J Acquir Immune Defic Syndr 1993; 6:1311.
  18. Pons V, Greenspan D, Lozada-Nur F, et al. Oropharyngeal candidiasis in patients with AIDS: randomized comparison of fluconazole versus nystatin oral suspensions. Clin Infect Dis 1997; 24:1204.
  19. Sharon V, Fazel N. Oral candidiasis and angular cheilitis. Dermatol Ther 2010; 23:230.
  20. Vazquez JA, Skiest DJ, Nieto L, et al. A multicenter randomized trial evaluating posaconazole versus fluconazole for the treatment of oropharyngeal candidiasis in subjects with HIV/AIDS. Clin Infect Dis 2006; 42:1179.
  21. Benson CA, Kaplan JE, Masur H, et al. Treating opportunistic infections among HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America. MMWR Recomm Rep 2004; 53:1.
  22. Goa KL, Barradell LB. Fluconazole. An update of its pharmacodynamic and pharmacokinetic properties and therapeutic use in major superficial and systemic mycoses in immunocompromised patients. Drugs 1995; 50:658.
  23. Phillips P, De Beule K, Frechette G, et al. A double-blind comparison of itraconazole oral solution and fluconazole capsules for the treatment of oropharyngeal candidiasis in patients with AIDS. Clin Infect Dis 1998; 26:1368.
  24. Graybill JR, Vazquez J, Darouiche RO, et al. Randomized trial of itraconazole oral solution for oropharyngeal candidiasis in HIV/AIDS patients. Am J Med 1998; 104:33.
  25. Murray PA, Koletar SL, Mallegol I, et al. Itraconazole oral solution versus clotrimazole troches for the treatment of oropharyngeal candidiasis in immunocompromised patients. Clin Ther 1997; 19:471.
  26. Posaconazole (Noxafil) for invasive fungal infections. Med Lett Drugs Ther 2006; 48:93.
  27. Skiest DJ, Vazquez JA, Anstead GM, et al. Posaconazole for the treatment of azole-refractory oropharyngeal and esophageal candidiasis in subjects with HIV infection. Clin Infect Dis 2007; 44:607.
  28. Wilcox CM, Straub RF, Clark WS. Prospective evaluation of oropharyngeal findings in human immunodeficiency virus-infected patients with esophageal ulceration. Am J Gastroenterol 1995; 90:1938.
  29. Bonacini M, Young T, Laine L. The causes of esophageal symptoms in human immunodeficiency virus infection. A prospective study of 110 patients. Arch Intern Med 1991; 151:1567.
  30. Kanda N, Yasuba H, Takahashi T, et al. Prevalence of esophageal candidiasis among patients treated with inhaled fluticasone propionate. Am J Gastroenterol 2003; 98:2146.
  31. Samonis G, Skordilis P, Maraki S, et al. Oropharyngeal candidiasis as a marker for esophageal candidiasis in patients with cancer. Clin Infect Dis 1998; 27:283.
  32. Laine L, Dretler RH, Conteas CN, et al. Fluconazole compared with ketoconazole for the treatment of Candida esophagitis in AIDS. A randomized trial. Ann Intern Med 1992; 117:655.
  33. Barbaro G, Barbarini G, Di Lorenzo G. Fluconazole vs. flucytosine in the treatment of esophageal candidiasis in AIDS patients: a double-blind, placebo-controlled study. Endoscopy 1995; 27:377.
  34. Barbaro G, Barbarini G, Calderon W, et al. Fluconazole versus itraconazole for candida esophagitis in acquired immunodeficiency syndrome. Candida Esophagitis. Gastroenterology 1996; 111:1169.
  35. Barbaro G, Barbarini G, Di Lorenzo G. Fluconazole compared with itraconazole in the treatment of esophageal candidiasis in AIDS patients: a double-blind, randomized, controlled clinical study. Scand J Infect Dis 1995; 27:613.
  36. Wilcox CM, Darouiche RO, Laine L, et al. A randomized, double-blind comparison of itraconazole oral solution and fluconazole tablets in the treatment of esophageal candidiasis. J Infect Dis 1997; 176:227.
  37. Ally R, Schürmann D, Kreisel W, et al. A randomized, double-blind, double-dummy, multicenter trial of voriconazole and fluconazole in the treatment of esophageal candidiasis in immunocompromised patients. Clin Infect Dis 2001; 33:1447.
  38. Villanueva A, Gotuzzo E, Arathoon EG, et al. A randomized double-blind study of caspofungin versus fluconazole for the treatment of esophageal candidiasis. Am J Med 2002; 113:294.
  39. de Wet N, Llanos-Cuentas A, Suleiman J, et al. A randomized, double-blind, parallel-group, dose-response study of micafungin compared with fluconazole for the treatment of esophageal candidiasis in HIV-positive patients. Clin Infect Dis 2004; 39:842.
  40. Krause DS, Simjee AE, van Rensburg C, et al. A randomized, double-blind trial of anidulafungin versus fluconazole for the treatment of esophageal candidiasis. Clin Infect Dis 2004; 39:770.
  41. Spanakis EK, Aperis G, Mylonakis E. New agents for the treatment of fungal infections: clinical efficacy and gaps in coverage. Clin Infect Dis 2006; 43:1060.
  42. http://www.aidsinfo.nih.gov/guidelines/ (Accessed on June 11, 2012).
  43. Vazquez JA. Therapeutic options for the management of oropharyngeal and esophageal candidiasis in HIV/AIDS patients. HIV Clin Trials 2000; 1:47.
  44. Perfect JR, Marr KA, Walsh TJ, et al. Voriconazole treatment for less-common, emerging, or refractory fungal infections. Clin Infect Dis 2003; 36:1122.
  45. Villanueva A, Arathoon EG, Gotuzzo E, et al. A randomized double-blind study of caspofungin versus amphotericin for the treatment of candidal esophagitis. Clin Infect Dis 2001; 33:1529.
  46. Arathoon EG, Gotuzzo E, Noriega LM, et al. Randomized, double-blind, multicenter study of caspofungin versus amphotericin B for treatment of oropharyngeal and esophageal candidiases. Antimicrob Agents Chemother 2002; 46:451.
  47. Pettengell K, Mynhardt J, Kluyts T, et al. Successful treatment of oesophageal candidiasis by micafungin: a novel systemic antifungal agent. Aliment Pharmacol Ther 2004; 20:475.
  48. de Wet NT, Bester AJ, Viljoen JJ, et al. A randomized, double blind, comparative trial of micafungin (FK463) vs. fluconazole for the treatment of oesophageal candidiasis. Aliment Pharmacol Ther 2005; 21:899.
  49. Kartsonis N, DiNubile MJ, Bartizal K, et al. Efficacy of caspofungin in the treatment of esophageal candidiasis resistant to fluconazole. J Acquir Immune Defic Syndr 2002; 31:183.
  50. Anidulafungin (Eraxis) for Candida infections. Med Lett Drugs Ther 2006; 48:43.
  51. Lake DE, Kunzweiler J, Beer M, et al. Fluconazole versus amphotericin B in the treatment of esophageal candidiasis in cancer patients. Chemotherapy 1996; 42:308.
  52. Pursley TJ, Blomquist IK, Abraham J, et al. Fluconazole-induced congenital anomalies in three infants. Clin Infect Dis 1996; 22:336.
  53. Chandrasekar PH, Sobel JD. Micafungin: a new echinocandin. Clin Infect Dis 2006; 42:1171.
  54. Fichtenbaum CJ, Koletar S, Yiannoutsos C, et al. Refractory mucosal candidiasis in advanced human immunodeficiency virus infection. Clin Infect Dis 2000; 30:749.
  55. Maenza JR, Merz WG, Romagnoli MJ, et al. Infection due to fluconazole-resistant Candida in patients with AIDS: prevalence and microbiology. Clin Infect Dis 1997; 24:28.
  56. Maenza JR, Keruly JC, Moore RD, et al. Risk factors for fluconazole-resistant candidiasis in human immunodeficiency virus-infected patients. J Infect Dis 1996; 173:219.
  57. Goldman M, Cloud GA, Wade KD, et al. A randomized study of the use of fluconazole in continuous versus episodic therapy in patients with advanced HIV infection and a history of oropharyngeal candidiasis: AIDS Clinical Trials Group Study 323/Mycoses Study Group Study 40. Clin Infect Dis 2005; 41:1473.
  58. Martins MD, Lozano-Chiu M, Rex JH. Point prevalence of oropharyngeal carriage of fluconazole-resistant Candida in human immunodeficiency virus-infected patients. Clin Infect Dis 1997; 25:843.
  59. Fichtenbaum CJ, Powderly WG. Refractory mucosal candidiasis in patients with human immunodeficiency virus infection. Clin Infect Dis 1998; 26:556.
  60. Martins MD, Lozano-Chiu M, Rex JH. Declining rates of oropharyngeal candidiasis and carriage of Candida albicans associated with trends toward reduced rates of carriage of fluconazole-resistant C. albicans in human immunodeficiency virus-infected patients. Clin Infect Dis 1998; 27:1291.
  61. Cauda R, Tacconelli E, Tumbarello M, et al. Role of protease inhibitors in preventing recurrent oral candidosis in patients with HIV infection: a prospective case-control study. J Acquir Immune Defic Syndr 1999; 21:20.
  62. Centers for Disease Control and Prevention (CDC). Rapid assessment of injuries among survivors of the terrorist attack on the World Trade Center--New York City, September 2001. MMWR Morb Mortal Wkly Rep 2002; 51:1.
  63. Bozzette SA. Fluconazole prophylaxis in HIV disease, revisited. Clin Infect Dis 2005; 41:1481.
  64. Powderly WG, Finkelstein D, Feinberg J, et al. A randomized trial comparing fluconazole with clotrimazole troches for the prevention of fungal infections in patients with advanced human immunodeficiency virus infection. NIAID AIDS Clinical Trials Group. N Engl J Med 1995; 332:700.