Clotrimazole Troches vs Oral Nystatin for Oropharyngeal Candidiasis

Thomas Sharpton, MD
JAMA. 1988;259(10):1497. doi:10.1001/jama.1988.03720100019021.
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To the Editor.  —In the Nov 13 issue, Gombert et al1 imply that clotrimazole troches should be used as the drug of choice in preventing oropharyngeal candidiasis. They did not mention, however, two other forms of prophylaxis that are less expensive than nystatin oral solution. Nystatin vaginal suppositories (30 tablets for $5) have been used for years in the same manner as clotrimazole troches and are much less expensive (35 clotrimazole tablets cost $14). Recently, nystatin pastilles have become available (30 tablets for $15); they reportedly lack the bitter taste of the solution or suppository forms of nystatin. More important is the 15% incidence of abnormal results on liver function studies reported by the manufacturer in the 1987 Physicians' Desk Reference (an incidence that I can confirm in patients with acquired immunodeficiency syndrome who use clotrimazole).I would like to know how often the authors monitored levels of hepatic


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