Bibliographic Info
GuidelineGuidelines on the treatment of skin and oral HIV-associated conditions in children and adults
Year of Publication2014
Issuing InstitutionWHO
Recommendation
Status
Updated
Recommended in favor
Strong
Certainty of evidence
Moderate
Oropharyngeal candidiasis. In adults:
- Oral fluconazole 100–150 mg for seven to 14 days is recommended as the preferred treatment.
- When fluconazole is not available or contraindicated, alternatives include topical therapy with
nystatin suspension or pastilles, or clotrimazole troches.
Notes and Remarks
- 1)When there is no response to fluconazole after 14 days of treatment, consider a higher dose. If still no response, consider fluconazole resistance. Itraconazole may be an alternative regimen, but precautions regarding drug interactions should be observed.
- 2)When there are difficulties in swallowing, oesophageal candidiasis should be considered and treatment should be provided for a longer duration, 14–30 days. The use of maintenance therapy is not recommended.
- 3)In HIV-infected patients with oropharyngeal candidiasis, always ask for a history of dysphagia to rule out oesophageal candidiasis, which is always treated with systemic antifungals (fluconazole 3–6 mg/kg per day for 14 days). A diagnostic trial of systemic antifungal treatment is appropriate before performing an endoscopic examination.
- 4)The use of gentian violet is no longer recommended.
- 6)Check the breasts of a breastfeeding woman when she or her infant has oropharyngeal candidiasis and treat accordingly.
- 7)In addition to the drug treatment, ensure that the patient has adequate hydration and nutrition