Intravenous Fluconazole Therapy in the Management of Intractable Oro-Pharyngeal Candidiasis in HIV –Infected Children

Abstract

Background: Oral manifestations are among the earliest and most common clinical features seen in children and adults with HIV/AIDS. Oro-pharyngeal candidiasis, an AIDS defining illness, often heralds HIV progression, immune system deterioration and severe disability. Management is by the application of topical antifungal agents. In resistant or recurrent cases however, systemic antifungal agents are needed. The recommended agents are oral fluconazole or itraconazole, given for 1-2 weeks and continued for 1-2 weeks after clinical resolution. However intravenous fluconazole is readily available for children in our environment than the oral form.
Objective: To examine the efficacy and cost effectiveness of intravenous fluconazole in HIV- infected children with intractable /severe oropharyngeal candidiasis.
Patients and Methods:Twenty-six children aged 3 – 144 months with confirmed diagnosis of HIV/AIDS were admitted into our unit over a 10-months period. All had oropharygeal candidiasis. Eight of these were found to be resistant to nystain and Ketoconazole. They were treated with intravenous fluconazole for two weeks.
Results:All the 8 subjects responded favourably with clearance of infection within 5 days of therapy. One had recurrence of infection within 3 months of discontinuation of therapy. The cost of an oral capsule was higher than 100ml bottle of intravenous fluconazole, which was often enough for the treatment course in these children. There was no adverse reaction in any of the subjects.
Conclusion:Intravenous fluconazole is an effective therapy in the treatment of resistant oropharyngeal candidiasis in severely ill HIV-infected children.


Keywords: Oropharyngeal candidiasis, HIV-infected children, fluconazole therapy.

NQJHM Vol. 14 (2) 2004: pp. 118-120