Role of empiric therapy for new onset esophageal symptoms in HIV

What is the role of empiric therapy for new-onset esophageal symptoms in patients with HIV infection? 

Candida esophagitis is the most common cause of esophageal disease in patients with AIDS presenting with dysphagia or odynophagia. Because of this high prevalence, an empiric approach to new-onset esophageal symptoms with potent antifungal therapy is commonly undertaken and accepted. 

A fluconazole loading dose of 200 mg followed by 100 mg/day for 10 days should be instituted. 

Because Candida esophagitis responds rapidly to fluconazole, patients who do not symptomatically improve within the first few days of treatment should undergo endoscopic evaluation to exclude other causes of disease (viral esophagitis).

This is the only condition for which enough data exist to document empiric therapy. Empiric therapy for suspected viral, fungal, and parasitic diseases is not indicated.


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