Aug 19, 2005
I have esophageal candidiasis that is resistant to all the medications (azoles, etc). Amphoteracin seems to keep the infection "in check" (with ongoing candida present in vast scarring tissue, thus losing the effect of systemic medications) yet when I am off of it, it reappears. The side effects of the Ampho is prohibitive to continue on this medicine. Ironically, my immune system appears healthy (T-Cells are in the 700's & undetectable for 9 years now). Any suggestions? Nystatin as well as Gentian violet have also proven ineffective
Response from Dr. Young
Thanks for your post.
Azole resistant Candida infections can really be difficult. We've used some of the newer antifungals with some successes- Voriconazole sometimes works where the first-generation azoles haven't (fluconazole, itraconazole) and is available as an oral medication. Caspofungin is IV but is active against such Candidas and better tolerated than amphoteracin.
On a separate note, sometimes amphoteracin swish and swallow (oral) can have activity and avoid the difficult side effects of the IV administration.
Good luck, BY
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