CANDIDIASIS/OROPHARYNGEAL

Clinical Description

This is an infection of the mouth caused by Candida albicans. It is commonly known as oral thrush. The infection sometimes also affects the pharynx.

The predisposing factors include trauma, denture wearing, dryness of the mouth, inhaled steroids, radiotherapy, diabetes mellitus, antibiotic therapy, age extremes (infant, elderly), HIV/AIDS and immunosuppressants.

Signs and Symptoms

• Creamy white or yellow plaques on normal mucosa
• Patches on the palatal and buccal mucosa and dorsum of the tongue and gums.
• Removal of plaques reveals bleeding surface.

Investigations

• Periodic Acid Schiff (PAS)
• Potassium Hydroxide Smear (KOH)
• Sabouraud’s dextrose agar (SDA)

Pharmacological

• Give Nystatin oral suspension 100,000 IU every 6 hourly for 10-14 days
• Note: Oral suspension should be taken after food
• Review after 14 days
• Paint Gentian Violet aqueous solution 0.5 % on the lesions 6 hourly for 7 days
• Give Clotrimazole Troches 10 mg 8 hourly for 4 weeks (children)

ALTERNATIVELY

• Give Chlorhexidine 0.2% mouth rinses 8 hourly (should not be used together with Nystatin)
• If not resolved after 7 days:
• Continue with above treatment and add
• Ketoconazole 200-400 mg 12 hourly for 10-14 days
• Children: 1-4 years: Give Ketaconazole 50 mg 12 hourly for 10 - 14 days
• Children: 5-12 years: Give Ketaconazole 100 mg 12 hourly for 10 -14 days

Note:

• Ketoconazole interacts with the following ARVs: Nevirapine, protease inhibitors and Didanosine

Alternatively

• Give Fluconazole 6 mg/kg on day 1 (200 mg), then 3 mg/kg (100 mg) once a day for 14 days

For extensive candidiasis, give Amphotericin B 50 mg (5 ml every 8 hours per day) or 0.5 – 0.7 mg/kg/day for 5- 7 days

PROPHYLAXIS:

Adults

• Give Fluconazole 100 mg daily for long term

Children

• Give Fluconazole 3-6 mg/kg daily for long term