A randomized un-blinded study on the treatment of oropharyngeal and esophageal
candidiasis was conducted in Kinshasa (Zaire), among 141 inpatients with
AIDS and oropharyngeal
candidiasis, of whom 136 also had esophageal
candidiasis. The study compared the efficacy of
gentian violet mouth washes (1.5 ml 0.5% aqueous
solution b.i.d.), oral
ketoconazole (200 mg/day, after a meal) and
nystatin mouth washes (200.000 U oral
suspension q.i.d.). Patients treated with mouth washes swallowed their medication after mouth washing. Patients enrolled in this study had a very high mortality (probability of death: 41.6% after 14 days). After 14 days, 72 patients could be evaluated. At that time, oropharyngeal lesions had disappeared in similar proportions of patients treated with
gentian violet (11/26, 42%) and
ketoconazole (10/23, 43%), and in a lower proportion of patients treated with
nystatin (2/23, 9%; p less than 0.05). In esophageal
candidiasis,
ketoconazole seemed more efficient than both other treatments: esophageal lesions had disappeared in 5 (24%) of the 21 patients on
ketoconazole, compared to less than 10% of patients on both other treatments (p = 0.07). The suboptimal results observed with all 3 treatments could be explained by the profound immunosuppression of patients enrolled in the study. This study suggests that
gentian violet is effective treatment for oropharyngeal
candidiasis. As it is very cheap (0.5 US$/treatment course in Kinshasa), we suggest that its use should be assessed in larger studies.