From the Guidelines
Candidal esophagitis should be treated with a 14-21 day course of oral fluconazole, as it is highly effective and remains the preferred therapy 1. The treatment of candidal esophagitis typically involves the use of systemic antifungals, with fluconazole being the most recommended option due to its excellent esophageal tissue penetration and high bioavailability.
- The dosage of fluconazole is usually 200-400 mg on the first day, followed by 100-200 mg daily for 14-21 days.
- For patients who cannot tolerate oral medications, intravenous fluconazole at equivalent doses can be used.
- Alternative options include itraconazole oral solution 200 mg daily, however, it is less effective than fluconazole due to variable absorption 1.
- In cases of fluconazole-resistant Candida or treatment failure, echinocandins like caspofungin (50 mg daily IV) or micafungin (150 mg daily IV) are recommended, although experience with these agents is limited 2.
- Patients with HIV should continue their antiretroviral therapy, and those with recurrent infections may benefit from secondary prophylaxis with fluconazole 100-200 mg three times weekly.
- Treatment success can be monitored by symptom improvement, typically within 7 days, and patients should avoid acidic, spicy, or very hot foods during treatment to minimize discomfort.
- Those with persistent symptoms after 7-10 days of therapy should undergo repeat endoscopy to rule out resistant infection or alternative diagnoses.
From the FDA Drug Label
The recommended dosage of SPORANOX ® Oral Solution for esophageal candidiasis is 100 mg (10 mL) daily for a minimum treatment of three weeks. Treatment should continue for 2 weeks following resolution of symptoms. Doses up to 200 mg (20 mL) per day may be used based on medical judgment of the patient's response to therapy. A double-blind randomized study (n = 119, 111 of whom were HIV seropositive) compared itraconazole oral solution (100 mg/day) to fluconazole tablets (100 mg/day). The dose of each was increased to 200 mg/day for patients not responding initially. Treatment continued for 2 weeks following resolution of symptoms, for a total duration of treatment of 3–8 weeks Clinical response (a global assessment of cured or improved) was not significantly different between the two study arms, and averaged approximately 86% with 8% lost to follow-up.
Treatment of Esophageal Candidiasis:
- The recommended dosage is 100 mg (10 mL) daily for a minimum of three weeks.
- Treatment should continue for 2 weeks following resolution of symptoms.
- Doses up to 200 mg (20 mL) per day may be used based on medical judgment of the patient's response to therapy 3, 4.
- Clinical response rates were approximately 86% in a comparative study with fluconazole 3.
From the Research
Treatment Options for Candidal Esophagitis
- Systemic antifungal drugs are used to treat candidal esophagitis, given orally in a defined course 5
- Fluconazole and itraconazole are two azole antifungal drugs that have been compared in the treatment of esophageal candidiasis in AIDS patients 6
- Fluconazole has been shown to be effective in the treatment of oesophageal candidiasis in AIDS patients, with clinical and mycological cure achieved in all patients 7
- Fluconazole has been compared to itraconazole in the treatment of candida esophagitis in acquired immunodeficiency syndrome, with fluconazole showing a higher rate of endoscopic cure 8
Antifungal Drugs Used
- Fluconazole: a triazole antifungal drug that has been shown to be effective in the treatment of candidal esophagitis 6, 7, 8
- Itraconazole: a triazole antifungal drug that has been compared to fluconazole in the treatment of candida esophagitis 6, 8
- Voriconazole: a novel triazole antifungal that has been shown to have in vitro activity against yeasts and yeast-like fungi, including Candida species 9
Efficacy of Treatment
- Fluconazole has been shown to have a higher rate of endoscopic cure than itraconazole in the treatment of candida esophagitis in AIDS patients 6, 8
- Voriconazole has been shown to be effective in the treatment of candidal esophagitis, with clinical trials confirming its efficacy 9
- Treatment failure has been observed in some patients, with fluconazole showing a lower rate of treatment failure than itraconazole 8