By Dr Ananya Mandal, MD
Candida infection is a fungal infection. It is often easy to treat and symptoms resolve with the use of antifungal agents. However, there is a risk of recurrence.
There are different treatments for different types of Candidiasis. (1, 2, 3, 4, 5)
Treatment of Oral Candidiasis
Candida infection of the mouth needs to be treated with locally applied antifungal medication and sometimes antifungals in the form of pills.
While a patient with a relatively mild infection and good immune status may need only locally applied lotions or mouth paints of antifungal agents for therapy, an older patient or one with a depressed immunity and more severe infection may need orally administered antifungals as pills and a longer duration of therapy.
If left untreated oral thrush may spread to form invasive candidiasis, esophageal candidiasis etc.
Locally applied agents as mouth paints or gargles contain Clotrimazole, Nystatin etc.
Antifungal agents that need to be taken as pills contain Fluconazole or Itraconazole. These are needed if local agents do not show response.
If there is candidial esophagitis, intravenous Fluconazole or Itraconazole as pills may be given.
Severe cases that are non-responsive to these drugs may need a stronger antifungal agent - Amphotericin B.
Treatment of Genital and Vulvovaginal Candidiasis
Antifungal agents are applied locally in most cases. If the body does not respond to these then oral administration of antifungals are needed.
The locally applied drugs are available as vaginal suppositories or pessaries that are soft tablets or tampon like structures that may be inserted into the vagina. Creams that may be applied locally are also available.
Therapy may last between one day and a week. Mild to moderate infections may need a single dose or oral antifungal drug. They show an 80-90% cure rate.
However, in those who are non-responsive or who have a recurrence of the infection, longer therapy is needed.
Untreated vaginal thrush may pass between partners who have unprotected sexual intercourse.
Pregnant and breast feeding women need to be given local therapy as oral antifungal agents have a potential to cause harm to the unborn baby or interfere with breastfeeding.
Side effects with antifungal agents include nausea, vomiting, stomach upset, dizziness etc.
Alternative therapies for vulvovaginal Candidiasis includes use of tea tree oil or yoghurt applied locally.
Treatment of Invasive Candidiasis
Primarily, catheters that may be harbouring the culprit organism Candid have to be removed.
This form of infection needs oral and intravenous antifungal agents.
Usually several weeks of therapy is needed. Therapy may be prolonged in cases of severe infections in the immunocompromized.
Newborns with invasive Candidiasis need amphotericin B for at least 3 weeks.
In children and adults who are otherwise clinically stable fluconazole or echinocandin group of antifungal drugs like caspofungin, micafungin, or anidulafungin may be given.
Those with critically ill states need Amphotericin B or echinocandins. These patients need at least 2 weeks of therapy or until all evidence of the infection clears from the blood.
Treatment of Cutaneous Candidiasis
This is treated with topical antifungal agents like clotrimazole, econazole, ciclopirox, miconazole, ketoconazole, nystatin etc.
If there is an abcscess for mation, the pus is to be drained and oral antifungal agents like fluconazole or itraconazole are administered.
If nails are affected oral itraconazole is given daily for 3-6 months.
Treatment of Bladder infections with Candida
Fluconazole at 200 mg once daily orally for at least 10-14 days is administered.
If there is a urinary catheter, it could be harbouring the organism and needs to be removed.
If the condition persists sometimes an irrigation of the bladder with antifungal agent Amphotericin B is recommened.
Treatment of kidney or liver Candidiasis
These conditions need hospitalization and administration of intravenous antifungal agents.
Surgical therapy, like drainage of abscesses, removal of heart or joint prosthetic implants (e.g. heart valves or artificial joints) may be needed at times.
Prevention of Candidiasis
Prophylactic therapy – In patients who are receiving chemotherapy, organ transplant, bone marrow transplant, or who have a condition where immunity is suppressed (e.g. HIV AIDS infection) antifungal agents are administered to prevent Candidial infections.
Oral fluconazole is the drug of choice in these cases. Other drugs include posaconazole, or caspofungin.
Patients and families who may be at risk of Candidial infections need to be made aware of the risks.
Diabetics, immunocompromized or those on steroids need to be made aware of the possibility of thrush and need to be taught the symptoms of the condition for early diagnosis and treatment.
Edited by April Cashin-Garbutt, BA Hons (Cantab)
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