Oesophageal candidiasis points to immune depression of whatever course. HIV testing should be done immediately; if negative, a thorough work-up of cellular immunity is warranted. 

Oral and esophageal candidiasis are fairly frequent complications of large-acting antibiotics. Infection of lower parts of intestine is definitely rare if it exists.

Presence of yeasts in stools is devoid of any value.

Treatment is based on local-acting anti-candida. It is important to keep the medication a relatively long time in mouth before swallowing it and to take it in divided doses.

Sometimes, antibiotic-induced oro-esophageal candidiasis can herald immuno-deficiency like diabetes.

The patient needs to be referred to a dietitian. Candidiasis is common after antibiotic therapy. Normal bacterial flora has to be restored and this can be aid with some dietary changes. 

By killing bacteria, antibiotics "make room" for yeasts and other fungi. Candida can be a part of human endogenous flora, normally in oral and intestinal mucosa. It is no surprise to identify candidiasis after exposure to large spectrum antibiotics, like amoxicillin/clavulanate. However, as Dr. Maroy stresses, an immuno deficiency must be ruled out if there is no improvement with antibiotic suspension, restoration of normal intestinal flora and antifungals, like oral fluconazol or topical micostatin.

How was strep throat infection diagnosed?  Two courses of amoxiclav seems a prolonged therapy for a normal strep throat. Those are possible clues for immuno depression: diabetes, neoplasia, steroid therapy, HIV,...

Fluconazol in liquid formulation has the advantage of topical and systemic action simultaneously.

Systemic action is useless and disproportionate in this condition. 

Don't forget  bicarbonated water as mouthwashes which maintains the optimal alcaline pH, adverse for candida which prefere acidity.

Immunosupression has to be ruled out alongwith stoppage of antibiotics .

Addition of pre-probiotics  with a healthy diet is also necessary .

After 2 courses of AB it will take months till the normal  micro-biome restores. I give in that case humic acid and enterococcus faecalis. 

I think she needs oral antifungal therapy, generally fluconazole works fine

Thank you for your answers. 

The oral or esophageal candidiasis its a common complication of multiple courses of antibiotics, so give him treatment with oral fluconazol and if recurs with no obvious cause, start studying inmunosupresion. 

To raise a small point, is a diagnosis of oesophageal candidiasis possible on laryngoscopy alone? Oesophageal candidiasis often causes painful dysphagia.

Dear doctor,

I had two patients with esophageal candidasis and both of them were not immunosupressed. The first case was a man of 50 with no alcohol intake and no diabetes. We reaveled co-existance of  C. albicans, C. kefyr, and H. pylori. and the second case was woman of 33 with orofharengeal and esophageal candidiasis. Immunoglobulins were at referance range. In first case, control endoscopy showed almost complete healing treatment with fluconazole 200 mg for two weeks, the female patient showed resistance to fluconazole and needed additional intraconazole administration.

This may point to an underlying immune deficiency. Has an HIV-test be performed? Is tuberculosis ruled out?

This case should not be ignored and needs workup specially for immune deficiency

I agree Oesophageal candidiasis usually causes painful dysphagia and it might be associated with oral thrush or diagnosed by upper GIT endoscopy not laryngeoscopy .

Whenever patient has upper air way candidiasis or thrush you need to check if he/she is on inhaled steroid e.g asthmatic patients or receiving multiple cources of antibiotics like your patient,check also his HIV status. More extensive form of mucocutaneous candida might be associated with immune defecincy like HIV or underlying malignancy or patient reciving systemic steroids or other immunosuppresive drugs and other causes of immunedefecincy.

Treatment is with fluconazole for 2 weeks in case of eosophageal candidiasis.More importantly to diagnose the underlying casue of it.

Best of Luck

Streptococcal infection is susceptible to natural penicillins. Oropharingeal candidiasis could be a complication of antibiotics therapy, if there is no any other reason( Hiv, inhailed corticosterroids, immune suppressive agents). Anyway there is no need for macrolides  (they are not active against Candida infection and they can cause diarrhea) gastric acid suppression by PPi  can make conditions for candida growth. What's the aim of antihistamines prescription? For candidiasis antifungal drug should be used: fluconasole or nystatin  ( if regisrered) . Second one acts locally on mucosa membrane because it's not absorbed from git. 

Stoppage of antibiotics is necessary, Start antifungal therapy and Immune deficiency should ruled out.

Dear Dr Olha, antihistamines were superscribed because the patient has seasonal allergies.  

Do. you have laboratory Tests? If yes, can you share? Was HIV testing done?

HIV testing wasn't done. 

A young adult developed esophageal candiasis following 2 courses of antibiotic!! She needs evaluation for immunocompromized conditions; as well as appropriate antifungals.