From the Guidelines
For treating candidiasis of an ostomy, topical antifungal medications such as nystatin powder or cream are the first-line treatment, applied directly to the affected area around the stoma 2-3 times daily after gentle cleansing. This approach is crucial in managing the infection while minimizing the risk of morbidity and mortality associated with invasive candidiasis 1. The treatment should continue for 7-14 days, even if symptoms improve earlier, to ensure complete resolution of the infection.
Key Considerations for Treatment
- Apply nystatin powder or cream directly to the affected area around the stoma 2-3 times daily after gentle cleansing.
- Miconazole or clotrimazole creams (2%) are also effective alternatives, applied in a thin layer to the affected skin.
- Ensure the skin is completely dry before attaching a new ostomy appliance to maintain proper adhesion.
- For severe or persistent infections, oral fluconazole 150-200mg daily for 7-14 days may be necessary, as recommended for invasive candidiasis 1.
Prevention Strategies
- Keep the peristomal skin clean and dry to prevent moisture accumulation, which can lead to yeast overgrowth.
- Change the ostomy appliance regularly to prevent the buildup of bacteria and fungi.
- Use barrier products to protect the skin from moisture and irritation, reducing the risk of skin integrity compromise.
The environment around an ostomy, being warm and moist, creates ideal conditions for yeast overgrowth, particularly when skin integrity is compromised by stool or urine exposure 1. Therefore, prevention and early treatment are critical in managing candidiasis of an ostomy, focusing on maintaining skin integrity and preventing infection.
From the Research
Treatment Options for Candidiasis of an Ostomy
- The treatment options for candidiasis of an ostomy are similar to those for other forms of candidiasis, and include topical and systemic antifungal agents 2, 3, 4.
- Topical antifungal agents, such as nystatin, miconazole, and clotrimazole, are commonly used to treat candidiasis of the skin and mucous membranes, and may be effective for treating candidiasis of an ostomy 2, 3, 4.
- Systemic antifungal agents, such as fluconazole, may be used to treat more severe or recurrent cases of candidiasis, including those that do not respond to topical treatment 5, 2, 6, 4.
- Other systemic antifungal agents, such as itraconazole, voriconazole, and posaconazole, may also be used to treat candidiasis, although they are less commonly used than fluconazole 2, 3.
- Novel antifungal agents, such as echinocandins (anidulafungin, caspofungin) and isavuconazole, may also be effective for treating candidiasis, although they are not as widely used as other antifungal agents 2, 3.
Factors to Consider When Choosing a Treatment Option
- The severity and location of the candidiasis infection, as well as the patient's overall health and medical history, should be taken into account when choosing a treatment option 2, 3, 4.
- The potential for drug interactions and side effects should also be considered, particularly when using systemic antifungal agents 5, 2, 6, 4.
- The patient's ability to tolerate and adhere to the treatment regimen should also be considered, particularly when using topical antifungal agents that require frequent application 2, 3, 4.