Uncomplicated oropharyngeal candidiasis (OPC) infection can be effectively treated with topical therapy using clotrimazole troches or nystatin suspension (AII).
Oral fluconazole is recommended for moderate or severe OPC disease (AI*).
For fluconazole-refractory OPC, itraconazole oral solution is recommended, although it is less well tolerated than fluconazole (AI).
If OPC initially is treated topically, failure or relapse should be treated with oral fluconazole or itraconazole oral solution (AI*).
Systemic therapy is essential for esophageal disease (AI*).
Oral or intravenous fluconazole, amphotericin B, or an echinocandin (caspofungin, micafungin, anidulafungin), administered for 14 to 21 days, is highly effective for treatment of Candida esophagitis (AI*).
For fluconazole-refractory esophageal disease, oral therapy can include itraconazole solution or voriconazole (AIII).
Central venous catheters should always be removed when feasible in HIV-infected children with candidemia (AII).
In severely ill children with candidemia, an echinocandin is recommended. In less severely ill children who have not had previous azole therapy, fluconazole is an alternative therapy (AI*).
For patients infected with Candida glabrata or Candida krusei, an echinocandin is recommended (AII*).
For patients infected with Candida parapsilosis, fluconazole or amphotericin B is recommended (AII*).
Alternatively, an initial course of amphotericin B therapy can be administered for invasive candidiasis and then carefully followed by completion of a course of fluconazole therapy (BIII).
Data are insufficient to support routine use of combination antifungal therapy in children with invasive candidiasis (BIII).
The potential for drug interactions, particularly with antiretroviral drugs such as protease inhibitors, should be carefully evaluated before initiation of antifungal therapy (AIII).
Amphotericin B lipid formulations have a role in children who are intolerant of conventional amphotericin B (deoxycholate) or are at high risk of nephrotoxicity because of preexisting renal disease or use of other nephrotoxic drugs (BII).
Children with candidemia should be treated for at least 14 days after documented clearance of Candida from the last positive blood culture and resolution of neutropenia and of clinical signs and symptoms of candidemia (AII*).
