The recommended method to use PHP on an IIS server under Windows is using FastCGI. This method allows you to reuse resources similar to an ISAPI module but does not have the instabilities introduced through a multi-threaded PHP installation.
Microsoft has posted instructions on how to install PHP under FastCGI on their IIS.net website. You can see those instructions here:
http://www.iis.net/fastcgi/phpon60

Anecdotal perhaps, but I was getting random 500 errors at times running vBulletin on Windows 2003 with IIS6 with PHP running as ISAPI. After switching to fastcgi mode I have had no more such issues.