Which treatment is most appropriate for candidal esophagitis?

Candidal esophagitis, an infection of the esophagus caused by Candida species, is typically seen in immunocompromised patients, such as those with HIV/AIDS or those undergoing chemotherapy. The appropriate treatment for this condition is oral fluconazole, an antifungal medication that is effective in treating candidiasis.

Fluconazole works by inhibiting the synthesis of ergosterol, a critical component of fungal cell membranes, leading to increased permeability and ultimately cell death. Oral administration is often sufficient for esophageal candidiasis, making it a practical choice for treatment.

Other options, while they may be used in different contexts, are not appropriate for treating candidal esophagitis. Ganciclovir is primarily used for viral infections, specifically cytomegalovirus (CMV) infections. Acyclovir is effective against herpes simplex viruses and varicella-zoster virus but does not target fungal infections. Topical nystatin might be effective for oropharyngeal candidiasis but is not a standard treatment for esophageal involvement, as it often has limited efficacy in penetrating deep tissues or the esophagus.

Thus, oral fluconazole is the best choice for addressing candidal esophagitis due to its efficacy and