LETTER
Cost-Effective Treatment of Candida Esophagitis
Daniel S. Berman and
Barry D. Wenglin
15 May 1993 | Volume 118 Issue 10 | Pages 824-825
TO THE EDITOR:
Laine and colleagues' demonstration [1] that fluconazole is more effective than ketoconazole in treating candida esophagitis in patients with AIDS does not alter our position that ketoconazole is the primary therapy.
The investigators speak of endoscopic and clinical "cure" in the study patients. In treating human immunodeficiency virus (HIV)-infected patients over months and years, we have observed that it is the nature of candida pharyngitis and esophagitis to recur. We have also encountered the sequence of treatment failure with ketoconazole, followed by failure with fluconazole—even high doses intravenously administered—and have had to use amphotericin B despite its side effects.
Candida esophagitis is not a fatal disease. Delay in treatment prolongs pain and causes decreased food intake but has no long-term effects. We propose therapy with ketoconazole, 200 mg twice daily, accepting a relatively high failure rate. If clinical or endoscopic cure is not achieved, we would use fluconazole. This might slow the dangerous sequence we have described and improve the overall care of patients with AIDS.
1. Laine L, Dretler RH, Conteas CN, Tuazon C, Koster FM, Sattler F, et al. Fluconazole compared with ketoconazole for the treatment of candida esophagitis in AIDS: a randomized trial. Ann Intern Med. 1992; 117:655-60.
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