From the Guidelines
Esophageal candidiasis after surgery should be treated with fluconazole 400 mg/d, as it is the primary recommended treatment according to the 2016 guidelines for the use of antifungal agents in patients with invasive fungal diseases in Taiwan 1. The treatment duration should be for 14-21 days until clinical improvement is seen.
- Alternative treatments include echinocandin, itraconazole, or voriconazole, which can be considered in cases of fluconazole resistance or intolerance.
- The use of antifungal therapy in esophageal candidiasis is crucial to prevent complications and improve patient outcomes, especially in immunocompromised patients or those with severe disease.
- The diagnosis of esophageal candidiasis is typically made by endoscopy with visualization of white plaques and fungal culture confirmation.
- Patients should continue antifungal therapy for at least 7 days after symptom resolution, and treatment should begin promptly after diagnosis.
- It is also important to note that the treatment of esophageal candidiasis should be individualized based on the patient's underlying condition, severity of disease, and potential interactions with other medications.
- The 2017 WSES consensus conference recommends empirical antifungal therapy in patients with septic shock or post-operative infections, where the presence of yeast is associated with a poor prognosis 1.
- However, the primary recommendation for esophageal candidiasis treatment remains fluconazole, as stated in the 2016 guidelines 1.
From the Research
Esophageal Candidiasis After Surgery
- Esophageal candidiasis is a common type of infectious esophagitis, particularly in immunocompromised patients, including those with HIV/AIDS, leukemia, diabetes, and those receiving corticosteroids, radiation, and chemotherapy 2.
- The disease can be diagnosed through endoscopic examination, which shows white mucosal plaque-like lesions and exudates adherent to the mucosa, and can be confirmed histologically by taking a biopsy or brushings of yeast and pseudohyphae invading mucosal cells 2.
- Treatment of esophageal candidiasis typically involves systemic antifungal drugs given orally in a defined course, with fluconazole being a commonly recommended option 3.
Treatment Options
- Fluconazole has been shown to be effective in treating esophageal candidiasis, with studies demonstrating its equivalence to amphotericin B in terms of clinical efficacy and superiority in terms of adverse effects 4.
- Comparisons between fluconazole and other azoles, such as itraconazole, have shown that fluconazole is associated with higher rates of endoscopic cure and clinical response 5, 6.
- A systematic review and meta-analysis of randomized controlled trials found no significant differences between fluconazole and comparators in terms of clinical response or combined clinical and endoscopic response, but found that fluconazole had higher mycological response rates and lower early relapse rates compared to echinocandins 3.
Patient Populations
- Esophageal candidiasis can occur in various patient populations, including those with immunosuppression, such as HIV/AIDS patients, and those with other underlying conditions, such as leukemia and diabetes 2.
- Studies have primarily focused on HIV-positive individuals, with limited data available on other patient populations, highlighting the need for further research in this area 3.