Effective antifungal therapy may be achieved with any of the following: fluconazole (100 mg orally daily for 7 days), ketoconazole (200–400 mg orally with breakfast [requires acidic gastric environment for absorption] for 7–14 days), clotrimazole troches (10 mg dissolved orally five times daily), or nystatin mouth rinses (500,000 units [5 mL of 100,000 units/mL] held in the mouth before swallowing three times daily). In patients with HIV infection, however, longer courses of therapy with fluconazole may be needed, and oral itraconazole (200 mg/day) may be indicated in fluconazole-refractory cases. Many of the Candida species in these patients are resistant to first-line azoles and may require newer drugs, such as voriconazole. In addition, 0.12% chlorhexidine or half-strength hydrogen peroxide mouth rinses may provide local relief. Nystatin powder (100,000 units/g) applied to dentures three or four times daily and rinsed off for several weeks may help denture wearers.