Frequent Oral Diseases in HIV Positive and AIDS Patients

Dr. Heddie O. Sedano, DDS

Therapeutic Protocols

The therapeutic protocols for pseudomembranous, erythematous and hyperplastic candidiasis are identical and include:

LOCAL TREATMENT

• Rx: Clotrimazole (Mycelex) troches 10mg.
• Disp: 50 troches.
• Sig: Dissolve 1 troche in mouth 5 times a day.

• Rx: Nystatin pastilles, 200,000 units.
• Disp: 50 pastilles.
• Sig: Dissolve 1 pastille in mouth 4 to 5 times a day.

NOTE: Re-exam the patient at the end of 10 days and prescribe the antifungal medication again if not fully treated. These troches and pastilles may contain carbohydrates therefore, do not prescribe for long periods of time in patients with xerostomia and/or bad oral hygiene, to prevent the development of caries.

Another Protocol is listed below:

• Rx: Nystatin (Mycostatin) vaginal troches, 100.000 units.
• Disp: 84 troches.
• Sig: Dissolve 1 troche in mouth 6 times a day.

NOTE: Re-exam the patient at the end of 14 days and prescribe again if not fully treated. Compliance to this medication may not be good because it has an acrid taste. Warn the patient about it. If large undissolved portions of the troche are ingested it may produce slight stomach discomfort. They are indicated in patients with xerostomia or bad oral hygiene because they do not have carbohydrates.

• Rx: Nystatin oral suspension 500,000 units per 5 ml.
• Disp: 200 ml.
• Sig: Rinse with 1 tsp. 5 times a day for 2 minutes and swallow.

NOTE: Most indicated in patients with xerostomia or bad oral hygiene.

SYSTEMIC TREATMENT

To be used in resistant cases to local therapy and in patients with a diagnosis of AIDS.

• Rx: Nizoral (Ketoconazole) tablets 200 mg.
• Disp: 15 tablets.
• Sig: First day 2 tablets then, 1 tablet per day.
  It is better taken with a meal, a snack or carbonated beverages to avoid stomach upset. Do not take within 2 hours (before or after) of taking antacids, buffered, or acid-reducing medications. Avoid alcoholic beverages while taking this drug.

NOTE: Possible side effects of this medication can be: diarrhea, nausea, vomiting, drowsiness, dizziness, menstrual irregularities, photophobia, breast tenderness, headache, skin rash, hives, itching, fatigue, loss of appetite, dark urine, pale stools, yellow skin or eyes, ulcers of the mouth, tongue or throat.

• Rx: Diflucan (Fluconazole) tablets 100 mg.
• Disp: 15 tablets.
• Sig: First day 2 tablets then, 1 tablet per day.

NOTE: Possible side effects of this medication can be: stomach upset, loss of appetite, altered taste, diarrhea, nausea, headache, dizziness, a skin rash or hives during the first few days. Diflucan interacts with Coumadin, Dilantin,the anti-histamines Seldane or Hismanal and Tagamet-like drugs and so is contraindicated in patients using these medications:

• Rx: Itraconazole capsules, 100 mg.
• Disp: 30 capsules.
• sig: 2 capsules after meals.

NOTE: Itraconazole should be prescribed to those patients which are highly resistant to Diflucan and have severe immune depression. WARNING: Any of the azole drugs, as the ones prescribed above, can induce the creation af azole-resistant Candida in patients with AIDS (see references relevant to candidiasis).

Pseudomembranous candidiasis
Acute atrophic candidiasis
Chronic hyperplastic candidiasis
Angular cheilitis
Other fungal infections
References relevant to candidiasis (with abstracts)

Classification

Do you wish to take this course for continuing education credit? Yes