What is the role of Diflucan (fluconazole) in treating laryngitis?

Fluconazole for Candidal Laryngitis

Fluconazole is effective for treating candidal laryngitis, particularly in mild to moderate cases, with a recommended dose of 200 mg daily for 7-14 days. 1

Diagnosis and Clinical Presentation

• Candidal laryngitis is a rare form of mucosal Candida infection that typically occurs in immunocompromised patients, particularly those with:

  • HIV/AIDS
  • Cancer or other immunosuppressive conditions
  • Long-term corticosteroid therapy
  • Diabetes mellitus

• Symptoms include:

  • Dysphonia (hoarseness)
  • Laryngeal stridor
  • Potential airway obstruction in severe cases

• Diagnosis requires:

  • Otolaryngologist-directed fiberoptic laryngoscopy or indirect laryngoscopy
  • Culture confirmation
  • Assessment of airway patency

Treatment Algorithm

First-line therapy:

• For mild to moderate cases:

  • Oral fluconazole 200 mg daily for 7-14 days 1

• For severe cases or impending airway obstruction:

  • Intravenous amphotericin B 0.7-1.0 mg/kg/day 1
  • Consider endotracheal intubation for airway management

For fluconazole-refractory disease:

1. Itraconazole solution 200 mg daily 1
2. Voriconazole 200 mg twice daily (oral or IV) 1
3. Echinocandins (micafungin 150 mg daily, caspofungin 70-mg loading dose then 50 mg daily, or anidulafungin 200 mg daily) 1

Evidence and Rationale

The Infectious Diseases Society of America guidelines recognize both intravenous amphotericin B and fluconazole as treatment options for laryngeal candidiasis 1. While most of the historical experience has been with amphotericin B, fluconazole has been successfully used in milder cases 1.

Case reports have documented successful treatment of candidal laryngitis and epiglottitis with oral fluconazole in HIV-infected patients 2, 3. These reports suggest that fluconazole is an effective and more convenient alternative to amphotericin B, especially for non-severe cases.

Important Considerations

• Early diagnosis and prompt treatment are critical to prevent potential airway obstruction and respiratory arrest 1
• Immunocompromised patients with dysphonia should be evaluated for candidal laryngitis, even in the absence of oral candidiasis 2
• Regular follow-up is essential to assess treatment response
• For patients with HIV, antiretroviral therapy should be optimized to reduce the risk of recurrent infections 1

Pitfalls to Avoid

• Mistaking candidal laryngitis for bacterial laryngitis or other conditions
• Delaying treatment in immunocompromised patients with dysphonia
• Failing to assess airway patency in severe cases
• Not considering fluconazole-resistant Candida species in treatment failures

Successful treatment should result in resolution of laryngeal stridor, prevention of airway obstruction, and reduction in the risk of aspiration of inflammatory debris and infected Candida 1.