American Board of Internal Medicine (ABIM) Certification Practice Exam

Which medication is the first-line therapy for Candida esophagitis?

1. Nystatin

2. Fluconazole

3. Amphotericin B

4. Ketoconazole

The correct answer is: Fluconazole

Fluconazole is recognized as the first-line therapy for Candida esophagitis due to its efficacy and safety profile. This antifungal medication is part of the triazole class and works by inhibiting the synthesis of ergosterol, a critical component of the fungal cell membrane. Fluconazole is well-absorbed orally, making it a convenient option for outpatient treatment. Candida esophagitis typically presents in immunocompromised patients, particularly those with HIV/AIDS or those receiving immunosuppressive therapy. Fluconazole’s spectrum of activity covers Candida species effectively, including the most common cause of esophageal candidiasis, Candida albicans. It is generally well tolerated, and dosing can be adjusted to achieve therapeutic levels based on the severity of the infection. Other medications mentioned, such as nystatin, while useful in oral candidiasis, are less effective for esophageal disease as they rely on topical application rather than systemic absorption. Amphotericin B, although potent, is typically reserved for severe cases or those resistant to first-line therapy due to its side effects and the need for intravenous administration. Ketoconazole, an imidazole antifungal, is less commonly used now because of its interactions with other medications and potential hepatic