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Cost-Effective Treatment of Candida Esophagitis
- Daniel S. Berman, MD; and
- Barry D. Wenglin, MD
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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 fluconazoleeven high doses intravenously administeredand 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.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
