Treatment of Candidal Esophagitis

First-Line Treatment Options

• The Infectious Diseases Society of America recommends systemic antifungal therapy for candidal esophagitis, with oral fluconazole 200-400 mg daily for 14-21 days as the first-line treatment, based on strong recommendation and high-quality evidence 1, 2, 3
• A diagnostic trial of antifungal therapy is appropriate before performing an endoscopic examination, as recommended by the Infectious Diseases Society of America 1, 2

Alternative Options for Patients Unable to Tolerate Oral Therapy

• The Infectious Diseases Society of America recommends intravenous fluconazole 400 mg daily for patients who cannot take oral medications 2, 3
• Echinocandins, such as micafungin 150 mg daily, caspofungin 70 mg loading dose then 50 mg daily, or anidulafungin 200 mg daily, are effective alternatives for patients who cannot tolerate azoles, as recommended by the Infectious Diseases Society of America 3, 4

Management of Fluconazole-Refractory Disease

• For fluconazole-refractory cases, the Infectious Diseases Society of America recommends itraconazole solution 200 mg daily or voriconazole 200 mg twice daily for 14-21 days 2, 3, 4
• Alternative options for fluconazole-refractory disease include echinocandins, such as micafungin 150 mg daily, caspofungin 70 mg loading dose then 50 mg daily, or anidulafungin 200 mg daily, for 14-21 days 3, 4

Prevention of Recurrence

• For patients with recurrent esophageal candidiasis, the Infectious Diseases Society of America recommends chronic suppressive therapy with fluconazole 100-200 mg three times weekly 3, 4
• For HIV-infected patients, antiretroviral therapy is strongly recommended to reduce the incidence of recurrent infections, as recommended by the Infectious Diseases Society of America 1, 3, 4