Treatment options for patients with oropharyngeal or esophageal candidiasis are limited usually to parenteral administration of amphotericin B. Some patients may respond to administration of other azoles (particularly itraconazole) or higher doses of amphotericin B. The objectives of this multicenter protocol are to compare the safety and efficacy of various doses of MK-0991 (an antifungal agent structurally similar to the echinocandin class) to amphotericin B for the treatment of these infections. Male or nonpregnant, nonlactating female patients ages 18-65 years with a diagnosis of mycologically-proven oropharyngeal or esophageal candidiasis will be recruited for this study. Patients with significant laboratory abnormalities (anemia, neutropenia, thrombocytopenia, renal insufficiency, hypoprothrombinemia, elevated liver function tests), allergy or significant intolerance to echinocandins or amphotericin B, amphotericin B failures, newly diagnosed opportunistic infections, esophagitis of other etiologies, unable to undergo esophagoscopy (if esophageal involvement evident), acute or chronic hepatitis, or selected concomitant nephrotoxins, rifampin, rifabutin, or ritonavir will be excluded. Consenting patients will receive a complete physical and medical history. A chest x-ray, electrocardiogram, and procedures to obtain samples of the infection (oropharyngeal swab or esophagoscopy) will be performed as part of routine care. Blood and urine collections will be taken. The medication will be selected at random, with an even chance of receiving one of four treatments.
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