HIV: Opportunistic infections, treatment of candidiasis

Candida albicans

in the mouth, throat and oesophagus causes difficulty in swallowing. This fungal infection can be treated with gentian violet or nystatin tablets, ketoconazole (Nizoral®), topical miconazole (Daktarin®), systemic itraconazole (Sporanox®) or fluconazole (Diflucan®). Gentian violet (1.5 ml 0.5 % aqueous solution, 2 x per day) is cheap, but stains the mouth purple. Gentian violet does not help in oesophageal candidiasis. Itraconazole and fluconazole are very expensive. Buccal tablets containing miconazole in a prolonged release formulation can be placed under the upper lip for local (topical) treatment of oropharyngeal candidiasis. Voriconazole, a new triazole, is very promising but at the moment there is very little data on it. It is also active against Candida kruseii, a yeast that is inherently resistant to fluconazole. It penetrates the blood-brain barrier and can be used in cases resistant to amphotericin B. Caspofungin (Cancidas®) belongs to the new class of echinocandins, and is active against divers Candida species (C. albicans and several C. non-albicans, including C. krusei). The normal dose is 70 mg as a single start-dose, followed by 50 mg/day IV. For patients heavier than 80 kg, a daily dose of 70 mg/day is advised. In case of medium liver failure (Child-Pughscore 7-9) 35 mg/day as maintenance dose is advised. There is no need for dose-adjustment in case of renal failure.

Category: Medical Subject Notes , Medicine Notes , Pharmacology Notes