What is the oral treatment for candidiasis (fungal infection) of an ostomy (surgically created opening in the body, such as a colostomy or ileostomy)?

From the Guidelines

For oral treatment of candidiasis in an ostomy, fluconazole is the recommended medication, with a typical regimen of 200 mg on the first day, followed by 100 mg daily for at least 14 days, as supported by the most recent and highest quality study 1. The treatment of candidiasis in an ostomy requires careful consideration of the patient's overall health and the severity of the infection.

• The goal of treatment is to alleviate symptoms, prevent complications, and improve quality of life.
• Fluconazole is a triazole antifungal agent that is effective against a wide range of Candida species, including C. albicans, C. glabrata, and C. krusei.
• The recommended dosage of fluconazole for oral treatment of candidiasis in an ostomy is 200 mg on the first day, followed by 100 mg daily for at least 14 days, as stated in the 2016 update by the Infectious Diseases Society of America 1.
• If symptoms persist, treatment may be extended for up to 28 days.
• It's essential to take the full course of medication even if symptoms improve, to ensure complete eradication of the infection.
• Fluconazole can be taken with or without food, but should be taken at the same time each day.
• Potential side effects include nausea, headache, and abdominal pain.
• In addition to medication, proper ostomy care is crucial, including cleaning the ostomy site daily with warm water and mild soap, keeping the area dry, and using a barrier cream or powder to protect the skin around the stoma.
• If symptoms worsen or do not improve after a week of treatment, it's essential to consult a healthcare provider for further evaluation and guidance, as supported by the guidelines for treatment of candidiasis 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Oral Treatment for Candidiasis of an Ostomy

The oral treatment for candidiasis (fungal infection) of an ostomy involves the use of antifungal agents.

• Topical antifungal drugs such as nystatin and miconazole are commonly used to treat oral candidiasis 2.
• Other topical alternatives include amphotericin B or clotrimazole, although their availability may vary by country 2.
• For cases that do not respond to topical treatment, oral fluconazole can be effective 2.
• Systemic treatment alternatives, such as itraconazole, voriconazole, or posaconazole, can be used for recalcitrant infections 2.
• Newer options include echinocandins (anidulafungin, caspofungin) and isavuconazole, with the latter available for both oral and intravenous use 2.

Comparison of Antifungal Agents

Studies have compared the effectiveness of different antifungal agents in treating oral candidiasis.

• A comparative evaluation of fluconazole and clotrimazole found that fluconazole had a slightly better clinical cure rate, while the mycological cure rate was approximately similar 3.
• A systematic review and meta-analysis of clinical trials found that nystatin was effective in treating oral candidiasis, with a significant reduction in Candida species colony-forming units per milliliter (CFU/mL) 4.
• Itraconazole has been shown to be effective in treating oral candidosis, with a faster response rate and equivalent clinical cure rates compared to clotrimazole 5.

Treatment Considerations

When treating oral candidiasis, it is essential to consider the patient's individual needs and the severity of the infection.

• Topical antifungal agents are generally preferred to minimize systemic adverse effects 6.
• Patients with chronic or recurrent infections or those who are immunocompromised may require increased dosage and extended duration of antifungal therapy 6.