FLUCONAZOLE VERSUS AMPHOTERICIN-B IN THE TREATMENT OF ESOPHAGEAL CANDIDIASIS IN CANCER-PATIENTS

Thirty-one patients with malignancy and endoscopy-confirmed symptomati c esophageal candidiasis were randomly assigned to receive oral flucon azole, 200 mg once daily, or intravenous amphotericin B, 0.3 mg/kg, ov er 1-4 weeks; Clinical efficacy was determined weekly and follow-up es ophageal endoscopy with biopsy and culture performed whenever possible . Both agents produced rapid resolution of symptoms, especially dyspha gia and odynophagia. All 13 evaluable patients in the fluconazole grou p and 10/12 treated with amphotericin had clinical improvement. Endosc opy showed eradication of the fungus in all 11 patients undergoing-rep eat endoscopy, with cure or improvement of esophagitis. The incidence of adverse effects attributable to treatment was higher in the amphote ricin group. The efficacy of oral fluconazole in esophageal candidiasi s appears to be equivalent to that of amphotericin, with fewer adverse reactions.