Clinical Manual for Management of the HIV-Infected ... - myCME.com

Maintenance therapy
Use caution when considering chronic maintenance
therapy, because it has been associated with refractory
and azole-resistant candidiasis, as noted above.
Fluconazole 100-200 mg daily or weekly, or itraconazole
solution, can be effective for patients who have had
multiple recurrences of oral or esophageal disease (azole
sensitive). Patients who achieve immunologic and
virologic responses to antiretroviral therapy may be able
to discontinue maintenance therapy.
Patient Education
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Patients should maintain good oral hygiene by
brushing teeth after each meal.
A soft toothbrush should be used to avoid mouth
trauma.
Advise patients to rinse the mouth of all food before
using lozenges or liquid medications.
Tell patients to avoid foods or liquids that are very
hot in temperature or very spicy.
Patients who have candidiasis under a denture or
partial denture should remove the prosthesis before
using topical agents such as clotrimazole or nystatin.
At bedtime, the prosthesis should be placed in a
chlorhexidine solution until reinsertion it into the
mouth.
Pregnant women or women who may become
pregnant should avoid azole drugs (eg, fluconazole,
itraconazole, voriconazole) during pregnancy because
they can cause skeletal and craniofacial abnormalities
in infants.
References
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Section 6—Disease-Specific Treatment | 6–7
Centers for Disease Control and Prevention,
National Institutes of Health, HIV Medicine
Association/Infectious Diseases Society of America.
Treating Opportunistic Infections Among HIV-Infected
Adults and Adolescents. MMWR Recomm Rep.
2004 Dec 17; 53(RR15);1-112. Available online
at aidsinfo.nih.gov/Guidelines/GuidelineDetail.
aspx?GuidelineID=14. Accessed May 19, 2006.
Fichtenbaum CJ. Candidiasis. In: Dolin R, Masur H,
Saag MS, eds. AIDS Therapy, 2nd ed. Philadelphia:
Churchill Livingstone; 2003:531-542.
Mönkemüller KE, Wilcox CM. Diseases of the
Esophagus, Stomach, and Bowel. In: Dolin R,
Masur H, Saag MS, eds. AIDS Therapy, 2nd ed.
Philadelphia: Churchill Livingstone; 2003:885-901.
Pappas PG, Rex JH, Sobel JD, et al. Guidelines for
treatment of candidiasis. Clin Infect Dis. 2004 Jan
15;38(2):161-89.
U.S. Public Health Service, Infectious Diseases
Society of America. 2002 Guidelines for preventing
opportunistic infections among HIV-infected persons.
MMWR Recomm Rep. 2002 Jun 14;51(RR08);1-
46. Available online at aidsinfo.nih.gov/Guidelines/.
Accessed May 19, 2006.