We conducted a randomized prospective study to compare the efficacy of oral miconazole and ketoconazole in the treatment of candida esophagitis in acquired immune deficiency syndrome (AIDS) patients in Haiti. Twelve AIDS patients with endoscopic and microscopic diagnoses of candida esophagitis were placed on either oral miconazole or ketoconazole for 10 days. All six patients receiving oral miconazole, and four of the six receiving ketoconazole had complete resolution of their esophageal lesions at the end of treatment. We conclude oral miconazole is at least as effective as ketoconazole in the treatment of candida esophagitis in AIDS patients.