Candidiasis
Prevention of Exposure
Candida organisms are common on mucosal surfaces and
skin. No measures are available to reduce exposure to these fungi.
Data from a prospective controlled trial indicate that fluconazole can reduce the risk of mucosal (oropharyngeal, esophageal, and vaginal) candidiasis (and cryptococcosis as well) in patients with advanced HIV disease. However, routine primary prophylaxis is not recommended because of the effectiveness of therapy for acute disease, the low mortality associated with mucosal candidiasis, the potential for resistant Candida organisms to develop, the possibility of drug interactions, and the cost of prophylaxis.
Prevention of Recurrence
Many experts do not recommend chronic prophylaxis of recurrent oropharyngeal
or vulvovaginal candidiasis for the same reasons that they do not recommend
primary prophylaxis. However, if recurrences are frequent or severe, intermittent
or chronic administration of an oral azole (fluconazole, ketoconazole, or itraconazole) may be considered. Other factors that influence
choices about such therapy include the impact of the recurrences on the patient's
well-being and quality of life, the need for prophylaxis for other fungal
infections, cost, toxicities, and drug interactions.
Adults or adolescents who have a history of documented esophageal candidiasis, particularly multiple episodes, should be considered candidates for chronic suppressive therapy with fluconazole.
Notes:
Pediatric Notes
Primary prophylaxis of candidiasis in HIV-infected infants is not
indicated.
Suppressive therapy with systemic azoles should be considered for infants who have severe recurrent mucocutaneous candidiasis and particularly for those who have esophageal candidiasis.
Note Regarding Pregnancy
There is limited experience with the chronic use of antimycotic drugs
during human pregnancy; three cases of infants born with craniofacial and
skeletal abnormalities following prolonged in-utero exposure to fluconazole
have been reported. Therefore, chemoprophylaxis against oropharyngeal,
esophageal, or vaginal candidiasis should not be initiated during pregnancy. The drug should be discontinued for patients who conceive while being
administered the drug.
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