Note: Systemic antifungals are required for effective treatment of esophageal candidiasis (AI); topical therapy alone is not recommended (AI).

Preferred Therapy:

• Fluconazole 200-mg loading dose, followed by fluconazole 100–200 mg (up to 400 mg) PO or IV daily (AI); consider oral suspension for people with severe symptoms and difficulty swallowing.

• Itraconazole oral solution 200 mg PO daily (AI), or
• Isavuconazole 400 mg PO as a loading dose, followed by isavuconazole 100 mg PO daily (BI), or
• Isavuconazole 400 mg PO once-weekly (BI), or
• Voriconazole 200 mg PO or IV twice daily (BI), or
• Posaconazole oral suspension 400 mg (10 mL) PO twice daily for 1 day, then 400 mg daily (BI), or
• Posaconazole tablet 300 mg PO twice daily for 1 day, then 300 mg daily (BI), or
• Lipid formulation of amphotericin B 3-4 mg/kg IV daily (BI), or
• Caspofungin 70-mg loading dose IV, followed by 50 mg IV daily (BI), or
• Micafungin 150 mg IV daily (BI), or
• Anidulafungin 100 mg IV for one dose, then 50 mg IV daily (BI)

Note: A higher rate of esophageal candidiasis relapse has been reported with echinocandins than with fluconazole.