HIV in Children

CANDIDIASIS

Dr. Ira Shah
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Last Updated : 1st September 2012

Treatment


Early oral thrush can be treated with topical application of clotrimazole applied 4-6 hourly to oral mucosa for 7-14 days. Alternatively nystatin suspension administered as 4,00,000 - 6,00,000 U/ml (4-6 mL 4 times daily after feed for 1-10 days may be given. Only if nystatin or clotrimazole trouche/mouth paint is not available, then gentian violet may be used. In patients who fail topical therapy, oral fluconazole (3-6 mg/kg/day OD) for 7-14 days or itraconazole (2-5 mg/kg/dose OC BD) for 7-14 days may be given. Ketoconazole also can be used as a second-line therapy in dose of 5-10 mg/kg/day in BD doses for 14 days but is less effective than fluconazole or itraconazole. Intravenous amphotericin B (0.3-0.5 mg/kg/day) may be used as a last resort.

Esophageal candidiasis : For esophageal candidiasis, fluconazole is the drug of choice. It is given at dose of 3 mg/kg/day IV for 21 days changing to oral route once the child starts tolerating food. Itraconazole capsule is not useful for treatment of esophageal candidiasis, however oral solution may be given for 14-21 days. Variconazole and caspofungin have been used for a limited number of children and thus not recommended for esophageal or disseminated candidiasis.

Systemic candidiasis : Amphotericin B is the drug of choice in dose of 0.5-1.5 mg/kg OD IV over 1-2 hours for 14 to 21 days after the last positive blood culture and signs and symptoms have resolved. Flucytosine (100-1560 mg/kg/day in 4 doses) may be used in combination with amphotericin B in patients with severe invasive disease. Fluconazole may be used as an alternative to amphotericin B in stable patients who have not recently received azole therapy. Lipid amphotericin B can be used in patients who are intolerant to conventional Amphotericin B or have a pre-existing renal disease (54).

Prophylaxis


Primary prophylaxis :
Routine primary prophylaxis is not recommended because of effectiveness of therapy for acute disease, low mortality with candidiasis, potential for resistant candida to develop and possibility of drug interactions.

Secondary prophylaxis : Fluconazole (3-6 mg/kg OD PO) or Itraconazole (5 mg/kg PO OD) may be considered for infants who have severe recurrent mucocutanenous candidiasis and for those who have esophageal candidiasis.

CANDIDIASIS
Dr. Ira Shah
Incharge Pediatric HIV and TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India Consultant in Pediatric Infectious Diseases, Nanavati Hospital, Mumbai, India.
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