From the Guidelines
Oral candidiasis is best treated with antifungal medications, with first-line therapy being topical options like clotrimazole troches at a dosage of 10 mg 5 times daily or nystatin suspension at a concentration of 100,000 U/mL and a dosage of 4–6 mL 4 times daily for 7–14 days. For mild disease, these topical treatments are recommended 1.
Key Considerations
- For moderate to severe disease, oral fluconazole at a dosage of 100–200 mg daily for 7–14 days is recommended 1.
- For fluconazole-refractory disease, either itraconazole solution or posaconazole suspension are recommended 1.
- Good oral hygiene is essential during treatment, including regular brushing, flossing, and cleaning dentures thoroughly if worn.
- Dentures should be removed at night and soaked in antifungal solution.
- Addressing underlying risk factors is crucial, such as controlling diabetes, reducing corticosteroid inhaler use, limiting sugar intake, and avoiding smoking.
Treatment Options
- Clotrimazole troches: 10 mg 5 times daily for 7-14 days
- Nystatin suspension: 100,000 U/mL, 4–6 mL 4 times daily for 7-14 days
- Oral fluconazole: 100–200 mg daily for 7–14 days
- Itraconazole solution: 200 mg daily
- Posaconazole suspension: 400 mg twice daily for 3 days, then 400 mg daily for up to 28 days These treatments work by disrupting the fungal cell membrane or inhibiting ergosterol synthesis, which is essential for fungal cell wall integrity, effectively eliminating the Candida organisms causing the infection 1.
From the FDA Drug Label
Nystatin Oral Suspension, USP, is indicated for the treatment of candidiasis in the oral cavity. The recommended dosage of SPORANOX ® (itraconazole) Oral Solution for oropharyngeal candidiasis is 200 mg (20 mL) daily for 1 to 2 weeks.
Treatment Options for oral candidiasis include:
- Nystatin (PO): indicated for the treatment of candidiasis in the oral cavity 2
- Itraconazole (PO): recommended dosage is 200 mg (20 mL) daily for 1 to 2 weeks for oropharyngeal candidiasis 3
From the Research
Treatment Options for Oral Candidiasis
- Topical antifungal drugs such as nystatin and miconazole are commonly used to treat oral candidiasis, as they are very effective but may require a long treatment period 4
- Other topical alternatives include amphotericin B and clotrimazole, although their availability may vary by country 4
- Oral fluconazole is an effective treatment for oral candidiasis that does not respond to topical treatment, and other systemic alternatives include itraconazole, voriconazole, and posaconazole 4, 5
- Newer treatment options include echinocandins (anidulafungin, caspofungin) and isavuconazole, which can be used intravenously or orally 4
- Other potential treatments being researched include ibrexafungerp, antibodies, cytokines, and antimicrobial peptides 4
Systemic Treatment Alternatives
- Fluconazole is often the drug of choice for systemic treatment of oral candidiasis due to its good antifungal properties, high patient acceptance, and efficacy compared to other antifungal drugs 5
- However, fluconazole may not always be effective, and other options like itraconazole or ketoconazole may be considered in cases where Candida strains are resistant to fluconazole 5
- Systemic antifungal treatments can be used to reduce the risk of acquiring resistance to antifungal drugs 6, 7