Table 1:

Pharmacologic management of eosinophilic esophagitis

Drug class	Adults and adolescents (≥ 12 yr)	Pediatric (≤ 11 yr)
Proton pump inhibitors	Induction: twice daily (e.g., pantoprazole 40 mg twice daily) Maintenance: once or twice daily (e.g., pantoprazole 40 mg daily or twice daily)	Weight-based dosage Induction: twice daily Maintenance: once or twice daily
Topical corticosteroids^*
Orodispersable tablets	Induction: 1 mg twice daily Maintenance: 0.5–1 mg twice daily (children < 18 yr not approved)	Not approved
Inhalers (e.g., fluticasone propionate)^†	Induction: 1–2 mg twice daily Maintenance: 250 μg–1 mg twice daily or 1 mg at bedtime	Induction: 250 μg–1 mg twice daily Maintenance: reduce induction dose by up to 50%
Slurry (e.g., budesonide slurry)^‡	Induction: 1 mg twice daily Maintenance: 0.25–1 mg twice daily	Induction: 1 mg twice daily Maintenance: 0.25–1 mg twice daily

↵* Patients should take their dose twice a day. If a patient has difficulty adhering to this regimen, an alternative is to dispense the total dose once a day. Topical absorption should be maximized by avoiding ingestion of food and drink for 30 minutes after taking the medication. To reduce oral candidiasis risk, patients should prioritize oral hygiene including brushing teeth or rinsing after ingesting. They should avoid swallowing water after administration to reduce washing off the medication.
↵† Off-label use of puffers or inhalational steroids: Care needs to be given to swallowing the puffs and not inhaling. Some practice is required to achieve good-quality doses into the esophagus. Patients may need education from a pharmacist.
↵‡ Off-label use of slurry: To reduce cost, slurry can be made at home. Budesonide capsules are opened and contents are mixed with 10 mL of antacid (aluminum hydroxide–magnesium hydroxide–simethicone), unsweetened applesauce, honey or maple syrup. (2)