Esophageal candidiasis
[Clin Infect Dis 2016;62:e1-50.]
- Always indicative of immunosuppression.
- Systemic antifungal therapy is always required.
- For recurrent infections, suppressive therapy with fluconazole 100-200mg PO 3x/week recommended.
Usual Pathogens
Candida albicans
Occasionally non-albicans spp
| Empiric Therapy | Duration | |
|---|---|---|
| Fluconazole | 200-400mg (3-6mg/kg) PO daily | 14-21 days |
Alternative if unable to tolerate oral therapy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Fluconazole | 400mg (6mg/kg) IV daily | 14-21 days |
| or | ||
| Anidulafungin | 200mg IV daily | 14-21 days |
| or | ||
| Caspofungin | 70mg IV once then 50mg IV daily | 14-21 days |
| or | ||
| Micafungin | 150mg IV daily | 14-21 days |
| or | ||
| Amphotericin B | 0.3-0.7mg/kg IV daily | 14-21 days |
Fluconazole-refractory - based on susceptibility results
| Empiric Therapy | Duration | |
|---|---|---|
| Itraconazole solution | 200mg PO daily | 14-21 days |
| or | ||
| Voriconazole | 200mg (3mg/kg) PO bid | 14-21 days |
| or | ||
| Posaconazole |
400mg suspension PO bid or 300mg DR tab PO daily |
14-21 days |
Azole-refractory - If esophageal candidiasis refractory to above regimens, consult Infectious Diseases regarding need for further investigation and therapy.