Immunocompromised patient oropharyngeal candidiasis

Twenty percent of HIV-infected patients develop fluconazole-resistant Candida albicans isolates after repeated exposure to fluconazole.33 To treat fluconazole-resistant oropharyngeal candidiasis, daily itraconazole for 2 to 4 weeks may be used. Oral itraconazole solution exhibits a mycological cure rate of 88% and a clinical cure rate of 97% in immunocompromised patients.34 Fluconazole-resistant esophageal candidiasis should be treated with intravenous amphotericin B or caspofungin. 

Prophylaxis to reduce incidence of oropharyngeal candidiasis in immunocompromised patients... 

Darouiche RO. Oropharyngeal and esophageal candidiasis in immunocompromised patients Treatment issues. Clin Infect Dis 1998 26 259-274. 

Since oropharyngeal and esophageal candidiasis are signs of immunocompromise, the immune status of the patient should be considered in the therapeutic care plan. For HIV-infected patients, this should also include an evaluation of the patient s antiretroviral therapy since fungal infections may represent deterioration in immune status. 

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