From the Guidelines
For the treatment of oral thrush, fluconazole 100-200 mg daily for 7-14 days is recommended, as it has been shown to be effective in treating mild to severe cases of oropharyngeal candidiasis, according to the most recent and highest quality study 1. The treatment of oral thrush depends on the severity of the disease.
- For mild cases, nystatin suspension (100,000 units/mL) can be used, with 4-6 mL swished in the mouth for several minutes then swallowed, four times daily for 7-14 days.
- Alternatively, clotrimazole troches (10 mg) can be dissolved in the mouth five times daily.
- For more severe or resistant cases, fluconazole is the preferred treatment, with a dosage of 100-200 mg daily for 7-14 days, as recommended by the Infectious Diseases Society of America 1. It is essential to maintain good oral hygiene during treatment, including brushing teeth twice daily and cleaning dentures thoroughly if worn.
- For denture wearers, removing dentures at night and soaking them in antifungal solution can help prevent recurrence.
- Patients with recurrent thrush should be evaluated for underlying conditions like diabetes or immunosuppression, and avoiding broad-spectrum antibiotics when possible and limiting sugar intake may help prevent recurrence, as Candida thrives on sugar and antibiotics reduce competing bacteria 1. In cases of fluconazole-refractory disease, itraconazole solution or posaconazole suspension can be used as alternative treatments, as recommended by the Infectious Diseases Society of America 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.
Oral Thrush Treatment Options:
- Nystatin (PO): indicated for the treatment of candidiasis in the oral cavity 2
- Itraconazole (PO): recommended dosage for oropharyngeal candidiasis is 200 mg (20 mL) daily for 1 to 2 weeks 3
From the Research
Treatment Options for Oral Thrush
- Topical antifungal agents such as nystatin and miconazole are commonly used to treat oral thrush, as they are effective but may require a long treatment duration 4
- Other topical alternatives include amphotericin B, clotrimazole, and a novel sustained release clotrimazole varnish, which has shown improved clinical outcomes and patient compliance 4, 5
- Systemic antifungal agents like fluconazole, itraconazole, and posaconazole can be used to treat oral thrush that does not respond to topical treatment, with fluconazole being an effective preventative intervention 4, 6, 7
- Newer antifungal agents such as echinocandins (anidulafungin, caspofungin) and isavuconazole are also available, although their use may be limited by resistance and cost 4
Efficacy of Nystatin in Oral Candidiasis Treatment
- Nystatin has been shown to be effective in treating oral candidiasis, with a systematic review and meta-analysis finding it to be equally effective as photodynamic therapy in achieving clinical remission and reducing Candida species 8
- However, nystatin may not be as effective as other antifungal agents such as fluconazole, ketoconazole, and itraconazole in achieving clinical and mycological cure 7
Prevention and Management of Oropharyngeal Candidiasis
- Fluconazole has been shown to be an effective preventative intervention for oropharyngeal candidiasis, although its use may be limited by the potential for resistant Candida organisms to develop and cost 7
- Other antifungal agents such as clotrimazole, nystatin, and itraconazole may also be effective in preventing and treating oropharyngeal candidiasis, although more research is needed to determine their efficacy 7
- Low-cost alternatives such as gentian violet and other less expensive antifungal drugs may also be effective in treating oral candidiasis, although more research is needed to determine their efficacy 7