For low-risk patients, topical agents are first-line therapy for OPC, although systemic agents may be used for severe or unresponsive cases. For patients with severe OPC, oral fluconazole remains the agent of choice. Oral fluconazole administered for 2 weeks exhibits a mycological cure rate of 48% and a clinical cure rate

of 84% in HIV patients. Response occurs within 5 days in patients receiving 100 to 200 mg daily.16 Doses as low as 50 mg are effective, but clinical response is slow and potentially leads to resistance. Two weeks of oral itraconazole solution is as effective as fluconazole but is less well tolerated. Due to variable absorption, risk of toxicity, and potential for drug interactions, ketoconazole and itraconazole capsules are considered second-line alternatives to fluconazole.

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