Treatment of Candida Infections

Introduction to Candida Treatment

The American College of Physicians and the Infectious Diseases Society of America recommend fluconazole 100-200 mg daily for 7-14 days as the most effective first-line treatment for moderate to severe candida infections on the lips, oral pharynx, and skin, while topical agents like clotrimazole or nystatin are appropriate for mild cases 1, 2

For mild cases of oropharyngeal candidiasis, the Infectious Diseases Society of America recommends clotrimazole troches (10 mg 5 times daily) or nystatin suspension (100,000 U/mL, 4-6 mL four times daily) or pastilles (200,000 U, 1-2 pastilles 4-5 times daily) for 7-14 days 1, 2
For moderate to severe cases of oropharyngeal candidiasis, the Infectious Diseases Society of America recommends oral fluconazole (100 mg/day for 7-14 days) which is superior to topical therapy 1, 2
For esophageal candidiasis, the Infectious Diseases Society of America recommends systemic therapy with fluconazole (100 mg/day for 14-21 days) or itraconazole solution (200 mg/day) as highly effective 2, 3
For candidal skin infections, the Infectious Diseases Society of America recommends topical azoles and polyenes (clotrimazole, miconazole, nystatin) as effective, and emphasizes the importance of keeping the affected area dry 2

For fluconazole-refractory oropharyngeal candidiasis, the Infectious Diseases Society of America recommends itraconazole solution (>200 mg/day orally) as effective in approximately two-thirds of cases 1, 2
For fluconazole-refractory esophageal candidiasis, the Infectious Diseases Society of America recommends itraconazole solution (>200 mg/day orally) or intravenous amphotericin B (0.3-0.7 mg/kg/day) for otherwise refractory disease 2, 3

For denture-related candidiasis, the Infectious Diseases Society of America recommends thorough disinfection of the denture in addition to antifungal therapy for definitive cure 1, 2
For immunocompromised patients, such as those with HIV, the Infectious Diseases Society of America recommends more aggressive initial therapy, and for recurrent infections, suppressive therapy with fluconazole 100-200 mg three times weekly 1
The European Society of Clinical Microbiology and Infectious Diseases recommends antiretroviral therapy to reduce recurrent infections in HIV-infected patients 1, 5

The Infectious Diseases Society of America advises that treatment should continue for the full recommended duration even if symptoms resolve quickly 1
The Infectious Diseases Society of America notes that oropharyngeal fungal cultures are of little benefit as many individuals have asymptomatic colonization 2
The Infectious Diseases Society of America warns that azole-refractory infections are more common in patients with prior azole use and severely immunocompromised patients 4