The Main PI3K inhibitor Snare

Ketoconazole is thus not recommended for the management of OPC (DI). Echinocandins should Alectinib not be considered for OPC episodes caused by isolates that are susceptible to triazoles due to their parenteral availability and cost in comparison with fluconazole (DIII). Finally, any intravenous formulation of amphotericin B is also not recommended for the management of OPC due to numerous adverse events and associated nephrotoxicity (DIII). Antifungal therapy for OEC should be initiated without endoscopy, especially if patients have signs and symptoms of OEC and oropharyngeal lesions are suggestive of mucosal candidiasis (AIII). Topical agents are not effective enough and should be avoided (DIII). Oral fluconazole (200?mg/day for 14�C21?days) is the treatment of choice [46�C48] (AI). Intravenous formulation can be used in case of severe oesophagitis (Table?2). Itraconazole (oral solution) is an alternative agent that has been shown to be as effective clinically and mycologically as fluconazole, but endoscopic cure was found less frequently especially during short-term therapy in the itraconazole arm [46,47,49] (BI). Itraconazole capsules are not recommended because of limited oral bioavailability (DII) The addition of flucytosine to itraconazole is not superior to fluconazole and is not recommended [50] (DI). Voriconazole 200?mg twice daily Selleckchem PI3K inhibitor for 14�C21?day is equally as efficacious as Tryptophan synthase fluconazole, but associated with a higher incidence of adverse events [51] and more potential drug�Cdrug interactions, visual abnormalities and phototoxicity in ambulatory patients (BI). Oral flucytosine alone was tested against fluconazole but was proven less effective [52], in addition to potential side effects (DI). Oral ketoconazole was tested against fluconazole in a large double-blind trial, and endoscopic and clinical cure rates were inferior in the ketoconazole arm [48]. Ketoconazole was also tested in a small trial against itraconazole with a higher efficacy than itraconazole [42] (DI). Finally among azoles, posaconazole has not been specifically studied in the context of primary treatment of oesophagitis in azole susceptible isolates and should be reserved for refractory or resistant disease. The echinocandins have been evaluated for the treatment of AIDS-associated OEC mostly in comparison with fluconazole. However, these antifungals are only available parenterally and are much less convenient to use than oral azoles (CI). Caspofungin is associated with similar response rates and tolerability compared with fluconazole although higher relapse rates were observed with caspofungin [53]. Caspofungin has been shown superior (74�C91% efficacy) to amphotericin B (63%) in one study [54].