From the Guidelines
Oral candidiasis is best treated with oral fluconazole (100 mg/day for 7–14 days), as it is as effective as—and, in some studies, superior to—topical therapy. This recommendation is based on the guidelines for treatment of candidiasis published in the Clinical Infectious Diseases journal 1. The treatment options for oral candidiasis include:
- Clotrimazole troches (one 10-mg troche 5 times per day)
- Nystatin (available as a suspension of 100,000 U/mL [dosage, 4–6 mL q.i.d.] or as flavored 200,000 U pastilles [dosage, 1 or 2 pastilles 4–5 times per day for 7–14 days])
- Oral fluconazole (100 mg/day for 7–14 days)
- Itraconazole solution (200 mg/day for 7–14 days)
It is essential to note that oral fluconazole and itraconazole solution are as efficacious as each other 1. However, ketoconazole and itraconazole capsules are less effective than fluconazole due to variable absorption 1.
For patients with recurrent episodes of oropharyngeal candidiasis, suppressive therapy is effective for preventing recurrent infections 1. Although it may increase the rate of development of isolates with an increased fluconazole MIC, the use of continuous suppression is recommended 1.
In clinical practice, it is crucial to address underlying factors that may contribute to the development of oral candidiasis, such as controlling blood sugar for diabetics, improving immune function, or discontinuing unnecessary antibiotics. Maintaining good oral hygiene, including regular brushing and cleaning of dentures if applicable, is also essential.
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:
- Nystatin (PO) is indicated for the treatment of candidiasis in the oral cavity 2.
- Itraconazole (PO) is recommended for the treatment of oropharyngeal candidiasis at a dosage of 200 mg (20 mL) daily for 1 to 2 weeks 3.
From the Research
Treatment Options for Oral Candidiasis
- The most commonly used topical antifungal drugs for oral candidiasis are nystatin and miconazole, which are very effective but require a long treatment duration to eradicate the infection 4.
- Other topical alternatives, such as amphotericin B or clotrimazole, may not be available in many countries, and their use may be limited by potential interactions with other drugs 4, 5.
- Oral fluconazole is effective in treating oral candidiasis that does not respond to topical treatment, and it is considered a drug of choice for systemic treatment due to its good antifungal properties, high patient acceptance, and efficacy compared to other antifungal drugs 4, 6.
- Other systemic treatment alternatives, such as itraconazole, voriconazole, or posaconazole, may be used in cases where Candida strains are resistant to fluconazole 4, 6, 7.
- Novel approaches in antifungal therapy, including the use of probiotics, echinocandins (anidulafungin, caspofungin), and isavuconazole, are being explored as potential treatment options for oral candidiasis 4, 5.
Factors Influencing Treatment Outcomes
- The incidence and treatment outcomes of oral candidiasis depend on the type of candidiasis, the virulence of the infection, and the presence of underlying risk factors, such as immunosuppression, diabetes, or broad-spectrum antibiotic use 5, 6, 8.
- The treatment of oral candidiasis should take into account the potential for drug interactions and the development of antifungal resistance, particularly with the use of systemic antifungal agents 4, 5, 8.
- Denture hygiene and the management of underlying risk factors are also important considerations in the prevention and treatment of oral candidiasis 8.