HIV in Children

TREATMENT FOR CANDIDA

Dr. Ira Shah
Share
Last Updated : 1st September 2012

Drugs

Dosage

Adverse Effects

Remarks
Clotrimazole mouth paint/trouche 10 mg orally 4 times daily for 14 days for oral thrush - Treatment of choice for oral thrush
Nystatin suspension 4,00,000 - 6,00,000 U 4 times daily for 7-14 days for treatment of oral thrush Bitter taste Alternative drug for oral thrush
Fluconazole

3-6 mg/kg/ OD PO for 7-14 days (max: 400 mg/dose) for oral thrush.

3-6 mg/kg/day IV/PO for 14-21 days (max: 400 mg/dose) for esophageal candidiasis

10-12 mg/kg/day IV/PO BD (max: 800 mg/day) for 4 weeks for systemic candidiasis.

Skin rash, pruritis, Stevens Johnson syndrome, Hepatitis, alopecia in scalp & pubic area. Fluconazole is the drug of choice for sophageal candidiasis. In uncomplicated systemic
candidiasis, fluconazole may be used for initial therapy or an initial course of amphotericin B may be followed by fluconazole to complete treatment.
Oral fluconazole is used for oral candidiasis if topical therapy fails.
Itraconazole Oral solution: 5 mg/kg/day PO BD (max: 200-400 mg/day for 7-14 days for oral candidiasis and for 14-21 days for esophageal candidiasis. GI upset, hepatitis, skin rash, pruritis, thrombocytopenia, leukopenia. Itraconazole solution is absorbed in presence of gastric acid and should be given without food whereas capsules should be given with food.
Itraconazole capsule is
ineffective for treatment of esophageal disease.
Itraconazole is a second line drug for esophageal candidiasis
Ketoconazole 5-10 mg/./kg/day PO BD x 14 days for oral thrush Nausea, vomiting, hepatitis, hemolytic, anemia, adrenal insufficiency, Gynaecomastia Inhibits P-450 cytochrome enzyme and this has drug interaction with antiretroviral drugs. Absorption is variable and thus is less effective than fluconazole or Itraconazole. Used as second line drug for oral thrush
Amphotericin B 0.3-0.5 mg/kg/IV OD for 7 days for esophageal candidiasis 0.5-1.5 mg/kg/day IV OD for

2-3 weeks after last positive blood culture and signs and symptoms have resolved for systemic candidiasis
Nephrotoxicity, fever, nausea, vomiting hepatotoxicity, anemia, neurotoxicity, hyperkalemia Amphotericin should be initiated at doses of 0.25-0.5 mg/kg/day & then increased to 0.5-1.5 mg/kg/day if tolerated. For severe disease it can be started at regular doses. Once patients with systemic candidiasis stabilize, it can be administered as 1.5 mg/kg alternate day
ipid Complex Amphotericin B 5 mg/kg/day IV OD for 2-4 weeks for systemic candidiasis Acute infusion related reactions such as chest pain, dyspnea, abdominal pain and urticaria. Useful in patients intolerant to conventional amphotericin B or have nephrotoxicity.
Liposomal Amphotericin B 3-5 mg/kg/day IV OD for 2-4 weeks for systemic candidiasis Acute infusion related reactions such as chest pain, dyspnea, hypoxia, abdominal pain, flushing and urticaria. Useful in patients intolerant to conventional amphotericin B or have nephrotoxicity
Flucytosine 100-150 mg/kg/day PO in 4 divided doses as an adjunct to Amphotericin B in patients with severe systemic candidiasis Bone marrow suppression, Hepatotoxicity, GI upset, renal and skin toxicity Should be avoided in children with severe renal involvement. TDM levels should be between 40-60 µg/ml.



TREATMENT FOR CANDIDA
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.