10 Patients can then be treated empirically with antifungal therapy. For patients who fail to respond, endoscopy can be used to evaluate for other diagnoses such as herpetic or cytomegalovirus esophagitis, idiopathic ulceration, or resistant candidiasis. Return to Contents Management Oral candidiasis. In general, topical therapy should be used initially, and systemic therapy reserved for more difficult problems such as treatment failures or noncompliance. Of the local therapies, troches generally are more effective than suspensions.
Most patients respond well to antifungal therapy.
Mycologic response rates are not usually as high, and Candida can still be cultured from the oral cavity in many patients. Not surprisingly, the relapse rate has ranged from 20 to 60 percent in published reports. Several studies have also been conducted comparing topical and systemic therapy. The clinical response rates are generally similar with all therapeutic regimens although signs and symptoms of disease tend to respond more rapidly to systemic therapy. Patients treated with topical agents are less likely to show mycologic clearance at the end of the treatment Studies comparing systemic treatments usually find them to be similar in clinical effectiveness, with response rates of 75 to l00 percent generally reported.