From the Guidelines
The best treatment for thrush is oral fluconazole at a dosage of 100–200 mg daily for 7–14 days, as recommended for moderate to severe disease. This is based on the guidelines from the Infectious Diseases Society of America, as outlined in the 2009 update by 1. For mild disease, alternative options include 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.
- Key considerations for treatment include:
- Disease severity: mild, moderate, or severe
- Patient factors: HIV infection, immune suppression, or other underlying conditions
- Treatment history: prior response to antifungal therapy or presence of fluconazole-refractory disease
- Additional recommendations from 1 include:
- Chronic suppressive therapy is usually unnecessary for patients with HIV infection
- If suppressive therapy is required, fluconazole at a dosage of 100 mg 3 times weekly is recommended
- Treatment with HAART is recommended to reduce recurrent infections
- For denture-related candidiasis, disinfection of the denture, in addition to antifungal therapy, is recommended.
From the FDA Drug Label
The recommended dosage of SPORANOX ® (itraconazole) Oral Solution for oropharyngeal candidiasis is 200 mg (20 mL) daily for 1 to 2 weeks. The best treatment for thrush (oropharyngeal candidiasis) is itraconazole oral solution at a dose of 200 mg (20 mL) daily for 1 to 2 weeks 2.
- Clinical signs and symptoms generally resolve within several days.
- Patients may be expected to relapse shortly after discontinuing therapy.
From the Research
Treatment Options for Thrush
- The most commonly used topical antifungal drugs for thrush are nystatin and miconazole, which are very effective but require a long treatment duration 3.
- Fluconazole is effective in treating thrush that does not respond to topical treatment and is a first-line management option for localized and systemic Candida albicans infections 4, 5.
- Itraconazole is a second-line therapy option for thrush that is non-responsive to fluconazole, and its solution formulation has been shown to be effective in AIDS patients with Candida albicans infections 4, 5.
- Other systemic treatment alternatives for thrush include voriconazole, posaconazole, and echinocandins such as anidulafungin and caspofungin 3, 6.
Antifungal Drug Resistance
- The increasing use of antifungal drugs has led to the development of drug resistance, with high resistance rates reported for fluconazole, itraconazole, and ketoconazole 7.
- Nystatin and amphotericin B have been shown to be highly effective against Candida spp, with low resistance rates, making them potential first-line treatment options for thrush 7.
Treatment Considerations
- The choice of antifungal drug for thrush treatment should be based on the severity of the infection, the patient's immune status, and the potential for drug interactions and resistance 4, 3, 5, 6.
- Topical antifungal drugs such as nystatin and miconazole are suitable for mild to moderate thrush infections, while systemic antifungal drugs such as fluconazole and itraconazole may be necessary for more severe or recurrent infections 3, 5.