What is the treatment for oral candidiasis?

From the Guidelines

The treatment for oral candidiasis typically involves antifungal medications, with fluconazole being the preferred treatment for moderate to severe cases, at a dosage of 100-200 mg daily for 7-14 days 1.

Treatment Options

• For mild disease, clotrimazole troches at a dosage of 10 mg 5 times daily, nystatin suspension at a concentration of 100,000 U/mL and a dosage of 4–6 mL 4 times daily, or 1–2 nystatin pastilles (200,000 U each) administered 4 times daily for 7–14 days is recommended 1.
• For moderate to severe disease, oral fluconazole at a dosage of 100–200 mg (3 mg/kg) daily for 7–14 days is recommended 1.
• For fluconazole-refractory disease, either itraconazole solution at a dosage of 200 mg daily or posaconazole suspension at a dosage of 400 mg twice daily for 3 days, then 400 mg daily for up to 28 days, are recommended 1.

Additional Considerations

• Patients should also address underlying factors that contribute to infection, including maintaining good oral hygiene, removing dentures at night and cleaning them thoroughly, controlling blood sugar if diabetic, and avoiding unnecessary antibiotic use.
• For those using inhaled corticosteroids, rinsing the mouth after use can help prevent infection.
• Candida infections occur when there's an imbalance in the normal oral flora, often due to immunosuppression, antibiotic use, or local factors that create a favorable environment for yeast overgrowth.
• Treatment should continue for at least 48 hours after symptoms resolve to prevent recurrence.

Key Points

• Fluconazole is the preferred treatment for moderate to severe oral candidiasis 1.
• Topical antifungals, such as clotrimazole and nystatin, are effective for mild disease 1.
• Addressing underlying factors that contribute to infection is crucial for preventing recurrence.

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 (PO): indicated for the treatment of candidiasis in the oral cavity 2
• Itraconazole (PO): recommended dosage is 200 mg (20 mL) daily for 1 to 2 weeks for oropharyngeal candidiasis 3

From the Research

Treatment Options for Oral Candidiasis

The treatment for oral candidiasis typically involves the use of antifungal medications. The choice of treatment depends on the severity of the infection and the patient's overall health.

• Topical antifungal drugs, such as nystatin and miconazole, are commonly used to treat oral candidiasis 4.
• These medications are effective but may require a long treatment period to eradicate the infection.
• Other topical alternatives, such as amphotericin B or clotrimazole, may not be available in all countries.
• Oral fluconazole is effective in treating oral candidiasis that does not respond to topical treatment 4, 5.
• Systemic treatment alternatives, such as itraconazole, voriconazole, or posaconazole, may be used in severe cases or in patients with recalcitrant infections 4.

Efficacy of Nystatin and Fluconazole

Studies have compared the efficacy of nystatin and fluconazole in treating oral candidiasis.

• A systematic review and meta-analysis found that nystatin pastille was superior to placebo in treating denture stomatitis, but nystatin suspension was not superior to fluconazole in treating oral candidiasis in infants, children, or HIV/AIDS patients 6.
• Another study found that fluconazole was more effective than nystatin in treating oral candidosis, with 87% of patients showing improvement after 7 days of treatment with fluconazole, compared to 80% of patients treated with nystatin 7.

Treatment Protocols and Safety

The treatment protocols and safety of nystatin and fluconazole have been evaluated in several studies.

• A descriptive study found that administration of nystatin suspension and pastilles in combination for 2 weeks may achieve a higher clinical and mycological cure rate, and using nystatin pastilles alone may have a higher mycological cure rate, when compared to using nystatin suspensions alone 6.
• The safety assessment of nystatin found that poor taste and gastrointestinal adverse reactions are the most common adverse effects 6.
• Fluconazole has been found to be well-tolerated, with fewer adverse effects compared to nystatin 7.