The Anti-Fungal Parade
By Kurt N. Woeller, DO and Tracy Tranchitella, ND

Candida is a common problem in chronic illnesses. My partner, Dr. Woeller and I have seen  many patients suffering from the ongoing resistance of candida to various treatments – both pharmaceutical and natural remedies. Candida and other yeasts have developed a growing resistance to anti-fungal medication. Just like bacteria that develop resistance to antibiotics, yeast can develop resistance also.

Most of the various forms of candida live in harmony in small amounts in our digestive system. They are a natural part of the eco-system in our guts, kept in check by normal intestinal bacteria.  However, when our immune resistance is down or the natural flora is disturbed, these commensal yeast start to flourish beyond their normal levels. If left untreated the yeast become invasive.  The yeast change form and embed themselves into the lining of our gut.  They actually start to grow roots. The longer they are left untreated the more invasive they become. It can be difficult to tell what treatment is going to work for any particular yeast overgrowth condition. A common antifungal medication called Nystatin works well - many times dramatically.  At other times having to use a variety of antifungal medication is warranted.  

Dr. Sidney Baker, a well-known Defeat Autism Now! and integrative medicine physician, coined the phrase  “antifungal parade” for a treatment approach to chronic cases of yeast overgrowth. What this treatment regimen involves is using various antifungal medications on a rotation basis to determine which one works the best.  Dr. Woeller has been using this approach with success for children with chronic, resistant yeast problems. Listed below is an example of the antifungal parade modified from Dr. Baker’s original recommendation. The list of therapies is only an example and can be modified based on specific needs, availability of medication, and tolerance. We have only listed prescription medication for simplicity sake, but understand that natural antifungals such as grapefruit seed extract, olive leaf extract, oregano oil, etc… can be used in conjunction with the medication.
Anti-Yeast Treatment Program

Most of these medications can be purchased from your local pharmacy with a prescription from your doctor. The oral Amphotericin B will need to come from a compounding pharmacy adept at making special formulations of oral suspensions and other blends that are preservative-free. The dosages listed are those commonly given to adults but the amounts can be modified for children. If you are seeking oral suspensions for these medications, the use of a compounding pharmacy may have to be employed as only a few medications come standard as both pills or liquid.p

• Nystatin Tablet (500,000 units) – one 3x daily for 10 days, then double the dose for 10 days, then switch to:
• Diflucan 200mg – one daily for 10 days, then double the dose for 10 days, then switch to:
• Amphotericin B 250mg - 4x daily for 10 days, then double the dose for 10 days, then switch to:
• Nizoral 200mg – one daily for 10 days, then double the dose for 10 days, then switch to:
• Nystatin Tablet (500,000 units) – one 3x daily for 10 days, then double the dose for 10 days, then switch to:
• Sporanox 100mg – one 2x daily for 10 days, then double the dose for 10 days, then switch to:
• Amphotericin B 250mg - 4x daily for 10 days, then double the dose for 10 days, then switch to:
• Lamisil 250 mg – one daily for 10 days, then double the dose for 10 days, then switch back to Nystatin.

This program can be repeated over and over again if needed.  Periodic blood work for liver function is warranted, but is much less of an issue because you are only taking a systemic antifungal, i.e. Diflucan, Nizoral, Sporanox or Lamisil for 3 weeks at a time. Usually, if any of these medications are taken for longer than 6 to 8 weeks continuously, liver function needs to be checked. The non-systemic antifungals, Nystatin and Amphotericin B, do not require blood work analysis as the effect is only local to the digestive system and they do not get systemically absorbed.

The antifungal parade allows for flexibility in the use of antifungal medications. You can start anywhere on the list. The point is to keep rotating from one to the other. A few additional things need to be made clear. One is that if a medication or natural supplement is showing good results it may not be the advisable to switch. Also, some of these medications will need prior authorization from your insurance company.  Usually, Sporanox and Lamisil are more difficult  to get while Nystatin, Diflucan or Nizoral are easier to obtain. Amphotericin B is only available in oral form from compounding pharmacies so this one is usually not covered by insurance.

For those of you suffering from chronic yeast issues, we hope you have found this information to be useful.

Tracy Tranchitella, ND and Kurt N. Woeller, DO are physicians at Stillpoint Center for Integrative Medicine in Temecula.  If you would like more information about Stillpoint Center, please call 951-693-2267 or go to www.mystillpoint.com