skip to main content

Oesophageal Candidiasis Treatment — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

EasyHIV MedicineOesophageal Candidiasis TreatmentSCE Infectious Diseases

A 30-year-old man with HIV (CD4 50) develops odynophagia and dysphagia. Endoscopy shows diffuse white plaques coating the oesophageal mucosa that can be scraped off. Biopsy shows pseudohyphae invading the squamous epithelium. What is the treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Fluconazole 200–400 mg daily for 14–21 days — first-line for oesophageal candidiasis

Oesophageal candidiasis (an AIDS-defining illness) is characterised by white adherent plaques with pseudohyphae on biopsy (distinguishing it from oral thrush, which does not require biopsy). Fluconazole 200–400 mg daily for 14–21 days is first-line. IV Echinocandins (Caspofungin, Micafungin) are reserved for Fluconazole-refractory disease or patients unable to swallow. Nystatin has negligible systemic absorption and cannot treat oesophageal disease. ART is the definitive long-term management. Oesophageal candidiasis at any CD4 count is an AIDS-defining condition.

Reference: BHIVA 2022 – OI guidelines; BNF 2024 – Oesophageal candidiasis