<s>[INST] Hi doctor, I need some advice on behalf of my mother who is 67 years old. For the past 12 days my mother has been experiencing pain in the throat area, feels like something is stuck, vomiting mucous, weakness, body aches, white tongue, difficulty swallowing, and vomiting feeling while talking and eating. She vomits about twice a day. She consulted an ENT and internal medicine doctor. ENT dismissed her after nothing found in throat using a camera but the internal medicine doctor did some investigations. Results showed UTI (epithelial cells 20-25/HPF and pus cells 30-35) and TSH (13.5) raised as well as Candida Albicans growth from a throat swab. She has had this issue every few months and normally clears up on its own, but this time it is very severe and not going away. Current medication: Cefotil (Cefuroxime 500 mg and Clavulanic acid 125 mg), Gelora gel for oral thrush (Miconazole BP 2%), Motigut for vomiting 10mg), Thyroxine (50 mcg currently but internal medicine doctor asked to increase the dose to 1.5 tablets due to high TSH). Urine culture was done and it was normal. My query is, whether this is a bad infection, not bacterial but growth of esophageal candidiasis can be treated by antifungal therapy Fluconazole? No improvements are seen with many antibiotics. Oral thrush candida was found on initial appointments and also candida in throat swab. Is there any harm in trying a course of Fluconazole? She had a history of fungal infections in the throat which normally clear up on its own. This time it seems much more serious. If it is fine, what dosage would you recommend and for what period? [/INST] Hello. Yes, your mother is suffering from 1. Hypothyroidism. 2. Oral candidiasis. 3. UTI (urinary tract infection). 4. Dysphagia. Oral candidiasis or oral thrush if not improved within five days after starting local antifungals then you may start oral antifungal medication. You may use tablet AF (Fluconazole) 150 mg once a day for one week. But in case of old age, people may feel nausea or vomiting for this drug then you can give iv Fluconazole (Forcan 100 ml) once a day for five days. In old age, vitamin B12 deficiency is also common, so it may present like glossitis with pharyngitis. Take vitamin B12 injection weekly once. You can give Neurobion injection also. Use Candid B mouth paint for local application. Use tablet Levosulfuride 25 mg twice a day for nausea and vomiting. At the same time check for serum electrolytes levels which may be altered in old age lead to vomiting. You may give probiotics like capsule Gut ok or Sporulac sachets to increase the immunity levels and also prevent gut growth of fungus. Remaining medications you continue the same. Response to the treatment may take four to five days. Diabetic patients are more prone to oral candidiasis so check for blood sugar. </s>