Multi-resistant oropharyngeal candidiasis after omeprazole therapy

Introduction: A 78-year-old spanish man and his wife reported recurrent episodes of oropharyngeal candidiasis since they started taking omeprazole. Neither of them presented immunosuppression at the time of the diagnosis. Both patients had taken multiple treatments for the refractory candidiasis, including different azole agents. In their latest pharyngeal swab, the Candida albicans isolated was resistant to all azole agents but sensitive to echinocandins, flucytosine and amphotericin B, so treatment with caspofungin was started in both patients. Results: No data have been found in the literature describing multiple-azole-resistant Candida albicans after long-term PPI therapy in immunocompetent patients. The Karch-Lasagna probability scale suggested that in both cases the oropharyngeal candidiasis was possibly related to omeprazole. Our patients had taken azole agents for years without discontinuing the drug associated with the adverse reaction. Discussion: Both patients developed recurrent and multi-resistant Candida albicans possibly linked to the hypochlorhydria produced by long-term PPI therapy