Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

Mucocutaneous Candidiasis

Last Updated: October 18, 2017; Last Reviewed: October 18, 2017

Treating Mucosal Candidiasis

Oropharyngeal Candidiasis: Initial Episodes (Duration of Therapy: 7–14 days)
Preferred Therapy:

  • Fluconazole 100 mg PO once daily (AI), or
Alternative Therapy:
  • Clotrimazole troches 10 mg PO 5 times daily (BI), or
  • Miconazole mucoadhesive buccal tablet 50 mg: Apply to mucosal surface over the canine fossa once daily (do not swallow, chew, or crush tablet). Refer to product label for more detailed application instructions, (BI) or
  • Itraconazole oral solution 200 mg PO daily (BI), or
  • Posaconazole oral suspension 400 mg PO BID for one day, then 400 mg daily (BI), or
  • Nystatin suspension 4–6 mL QID or 1–2 flavored pastilles 4–5 times daily (BII)

Esophageal candidiasis (Duration of Therapy: 14–21 days)
Note: Systemic antifungals are required for effective treatment of esophageal candidiasis (AI)
Preferred Therapy:

  • Fluconazole 100 mg (up to 400 mg) PO or IV daily (AI), or
  • Itraconazole oral solution 200 mg PO daily (AI)
Alternative Therapy:
  • Voriconazole 200 mg PO or IV BID (BI), or
  • Isavuconazole 200 mg PO as a loading dose, followed by 50 mg PO daily (BI), or
  • Isavuconazole 400 mg PO as a loading dose, followed by 100 mg PO daily (BI), or
  • Isavuconazole 400 mg PO once-weekly (BI), or
  • Caspofungin 50 mg IV daily (BI), or
  • Micafungin 150 mg IV daily (BI), or
  • Anidulafungin 100 mg IV for one dose, then 50 mg IV daily (BI), or
  • Amphotericin B deoxycholate 0.6 mg/kg IV daily (BI), or
  • Lipid formulation of amphotericin B 3-4 mg/kg IV daily (BIII)

Note: A higher rate of esophageal candidiasis relapse has been reported with echinocandins than with fluconazole.

Uncomplicated Vulvovaginal Candidiasis
Preferred Therapy:

  • Oral fluconazole 150 mg for 1 dose (AII); or
  • Topical azoles (i.e., clotrimazole, butoconazole, miconazole, tioconazole, or terconazole) for 3–7 days (AII)
Alternative Therapy:
  • Itraconazole oral solution 200 mg PO daily for 3-7 days (BII)

Note: Severe or recurrent vaginitis should be treated with oral fluconazole (100–200 mg) or topical antifungals for ≥7 days (AII)

Chronic Suppressive Therapy
  • Chronic suppressive therapy is usually not recommended unless patients have frequent or severe recurrences (BIII).
  • If used, it is reasonable to discontinue therapy if CD4 count >200 cells/mm3 (AIII).

If Decision Is To Use Suppressive Therapy
Oropharyngeal Candidiasis:

  • Fluconazole 100 mg PO once daily or 3 times weekly (BI)

Esophageal Candidiasis:

  • Fluconazole 100–200 mg PO daily (BI)
  • Posaconazole oral suspension 400 mg PO BID (BII)

Vulvovaginal Candidiasis:

  • Fluconazole 150 mg PO once weekly (BII)
Other Considerations
  • Chronic or prolonged use of azoles might promote development of resistance.
  • Systemic azoles may have significant drug-drug interactions with ARV drugs and other drugs for treatment of OI; refer to Table 5 for dosing recommendations. Consider therapeutic drug monitoring if prolonged use is indicated.

Key to Acronyms: ARV = antiretroviral; BID = twice daily; CD4 = CD4 T lymphocyte; IV = intravenous; OI = opportunistic infection; PO = orally; QID = four times daily

Download Guidelines