Fungal and Parasitic Infections USMLE Step 1 Practice Question

A 55-year-old man with HIV presents to the emergency department with a 5-day history of dysphagia, odynophagia, and fever. He reports oral thrush that began 2 weeks ago. Medical history is significant for nonadherence to antiretroviral therapy. Vital signs: temperature 38.7°C, heart rate 105/min, blood pressure 121/78 mmHg, respiratory rate 18/min, SpO2 99% on room air. Laboratory findings reveal CD4 count 38 cells/μL, and upper endoscopy shows white, adherent plaques diffusely involving the esophagus. Biopsy with KOH preparation demonstrates budding yeast and pseudohyphae consistent with Candida albicans. The patient has no history of azole use. Which of the following is the most appropriate initial pharmacologic management?