From the Guidelines
The treatment for oral candidiasis typically involves antifungal medications, with fluconazole being the preferred choice for moderate to severe cases, at a dosage of 100-200 mg daily for 7-14 days, as recommended by the most recent guidelines 1.
Treatment Options
- For mild disease, topical antifungals such as clotrimazole troches (10 mg 5 times daily) or nystatin suspension (100,000 U/mL, 4-6 mL 4 times daily) are recommended for 7-14 days 1.
- For moderate to severe disease, oral fluconazole is the preferred treatment, with a dosage of 100-200 mg daily for 7-14 days 1.
- For fluconazole-refractory disease, itraconazole solution or posaconazole suspension are recommended alternatives 1.
Important Considerations
- Patients should address underlying factors that may contribute to the infection, such as improving oral hygiene, properly cleaning dentures if applicable, and controlling blood sugar in diabetic patients.
- For those using inhaled corticosteroids, rinsing the mouth after use can help prevent recurrence.
- Antifungal therapy works by disrupting the fungal cell membrane or inhibiting essential fungal enzymes, preventing the growth and reproduction of Candida organisms.
- Treatment should continue for at least 48 hours after symptoms resolve to prevent recurrence.
Special Cases
- Denture-related candidiasis requires thorough disinfection of the denture for definitive cure 1.
- Chronic suppressive therapy with fluconazole may be necessary for patients with frequent or disabling recurrences, but should be used with caution to minimize the risk of antifungal resistance 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.
The treatment for oral candidiasis includes:
- Nystatin Oral Suspension, USP 2
- Itraconazole Oral Solution with a recommended dosage of 200 mg (20 mL) daily for 1 to 2 weeks 3
From the Research
Treatment Options for Oral Candidiasis
The treatment for oral candidiasis typically involves the use of antifungal agents, which can be administered topically or systemically.
- Topical antifungal agents, such as nystatin and miconazole, are commonly used to treat oral candidiasis 4.
- These agents are effective but may require a long duration of use to eradicate the infection.
- Systemic antifungal agents, such as fluconazole, are used to treat oral candidiasis that does not respond to topical treatment 4, 5.
- Other systemic treatment alternatives include itraconazole, voriconazole, and posaconazole 4, 5.
Antifungal Agents
Various antifungal agents are available for the treatment of oral candidiasis, including:
- Polyenes (nystatin, amphotericin B)
- Azoles (ketoconazole, miconazole, clotrimazole, fluconazole, itraconazole, voriconazole, posaconazole, isavuconazole)
- Echinocandins (caspofungin, micafungin, anidulafungin) 5
- Novel approaches, such as the use of probiotics, are also being explored 5.
Treatment Considerations
The treatment of oral candidiasis should take into account the clinical presentation and the patient's underlying health status.
- Patients with chronic or recurrent infection or those who are immunocompromised may require increased dosage and extended duration of antifungal therapy 6.
- The treatment should also consider the potential for drug interactions and adverse effects 4, 5.
- Good oral hygiene and denture hygiene are also important in the prevention and treatment of oral candidiasis 7.