From the Guidelines
Oral thrush is characterized by painless, creamy white, plaque-like lesions of the buccal or oropharyngeal mucosa or tongue surface, as described in the most recent guidelines 1. The characteristics of oral thrush include:
- Painless, creamy white, plaque-like lesions on the tongue, inner cheeks, gums, tonsils, or back of the throat
- Lesions can be easily scraped off with a tongue depressor or other instrument
- Less commonly, erythematous patches without white plaques can be seen on the anterior or posterior upper palate or diffusely on the tongue
- Angular chelosis is also noted on occasion and may be caused by Candida, as reported in previous studies 1 The most recent and highest quality study on the topic, published in 2016, provides a comprehensive overview of the clinical practice guidelines for the management of candidiasis, including oral thrush 1. Key points to note:
- Oral thrush is most often observed in patients with weakened immune systems, such as those with HIV infection, diabetes, leukemia, and other malignancies
- The use of antifungal medications, such as fluconazole, itraconazole, and posaconazole, is effective in treating oral thrush
- Good oral hygiene, including regular brushing and rinsing with saltwater, helps prevent recurrence
- Thrush commonly affects infants, the elderly, those with weakened immune systems, diabetics, and people using corticosteroid inhalers or broad-spectrum antibiotics.
From the Research
Oral Thrush Characteristics
Oral thrush, also known as oral candidiasis, is a common opportunistic infection that affects the oral mucosa. The characteristics of oral thrush include:
- Acute and chronic clinical presentations with diverse diagnostic and therapeutic approaches 2
- Lesions caused by Candida albicans and other organisms such as Candida glabrata, Candida krusei, Candida parapsilosis, and Candida dubliniensis 3
- Opportunistic infection that affects the young, old, and debilitating people 3
Treatment Options
The treatment options for oral thrush include:
- Topical antifungal drugs such as nystatin, miconazole, clotrimazole, and amphotericin B 2, 3, 4
- Systemic antifungal drugs such as fluconazole, itraconazole, voriconazole, and posaconazole 2, 5
- Newer antifungal drugs such as echinocandins (anidulafungin, caspofungin) and isavuconazole 2
- Other hopeful alternatives such as ibrexafungerp, or the use of antibodies, cytokines, and antimicrobial peptides 2
Efficacy of Antifungal Drugs
The efficacy of antifungal drugs in the treatment of oral thrush includes:
- Fluconazole showing a better clinical response rate than clotrimazole in adults with oral candidiasis 3, 4
- Miconazole and nystatin showing similar clinical response rates in infants with oral candidiasis 4
- Itraconazole, fluconazole, and ketoconazole being better than nystatin in reducing the mycological cure rate in oral candidiasis 5
- The effect of fluconazole in reducing the risk of the mycological cure rate in oral candidiasis being better than that of other drugs 5