From the Guidelines
Treatment options for esophageal candidiasis in patients intolerant to oral Fluconazole are limited, but alternatives such as itraconazole solution, voriconazole, and echinocandins like caspofungin, micafungin, and anidulafungin are available.
Alternatives to Fluconazole
- Itraconazole solution: effective in approximately two thirds of persons with fluconazole-refractory oropharyngeal candidiasis 1 and up to 80% of patients with fluconazole-refractory esophageal candidiasis will respond to itraconazole solution 1.
- Voriconazole: as efficacious as fluconazole and has shown success in the treatment of fluconazole-refractory mucosal candidiasis, but is associated with a higher rate of adverse events 1.
- Echinocandins: caspofungin, micafungin, and anidulafungin are effective alternatives to azole agents for refractory candidiasis, but are associated with higher relapse rates than fluconazole 1.
Key Considerations
- Intravenous amphotericin B: can be used among patients with refractory disease, but is usually reserved for severe cases 1.
- Posaconazole suspension: efficacious in approximately 75% of patients with refractory oropharyngeal or esophageal candidiasis, but is not the first-line treatment 1.
- Long-term suppressive therapy: with fluconazole is effective in preventing recurrences of esophageal candidiasis in patients with advanced AIDS, but may be associated with increased in vitro resistance 1.
From the Research
Treatment Options for Esophageal Candidiasis
In patients intolerant to oral fluconazole, several alternative treatment options are available for esophageal candidiasis. These include:
- Itraconazole oral solution, which has been shown to be clinically comparable to fluconazole in the treatment of esophageal candidiasis in immunocompromised patients 2
- Amphotericin B, which has been demonstrated to be effective in the treatment of esophageal candidiasis, although it may have a higher incidence of adverse effects compared to fluconazole 3
- Itraconazole-flucytosine association, which may represent an alternative therapeutic regimen for patients with fluconazole-resistant Candida esophagitis 4
- Ketoconazole, which has been shown to be effective in the treatment of Candida esophagitis, although its use may be limited due to potential side effects 5
Comparison of Treatment Options
Studies have compared the efficacy of different treatment options for esophageal candidiasis. For example:
- A study comparing fluconazole and itraconazole in the treatment of esophageal candidiasis in AIDS patients found that fluconazole was associated with a higher rate of endoscopic cure than itraconazole 6
- Another study comparing itraconazole oral solution and fluconazole tablets in the treatment of esophageal candidiasis found that both treatments were well tolerated and had comparable clinical response rates 2