Oral Candidiasis (Thrush)
Recurrent fungal infections are very common in children living with HIV. In particular, oral candidiasis is extremely prevalent. Esophageal candidiasis may occur with advanced HIV disease and cause discomfort, swallowing difficulties and weight loss. Symptoms and diagnosis of these infections are similar to those seen in adults.
Oral candidiasis may be treated with topical clotrimazole (Five 10mg trouches a day). Usually nystatin (Four 2-6mL doses every 6 hours) is ineffective in children who have recurrent oral thrush. Some parents have found gentian violet applied two to three times daily on affected areas a useful topical treatment, though studies have not been conducted to confirm these reports in children with HIV. Gentian violet should never be swallowed.
When topical treatment fails, use of fluconazole, itraconazole or ketoconazole is recommended. Doses are determined by weight of the child. As in adults, long-term preventative treatment may lead to development of resistance, therefore it is best to treat each occurrence of infection individually.
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