From the Guidelines
Oral thrush is best treated with oral fluconazole (100 mg/day for 7-14 days) as it is as effective as, and in some studies, superior to topical therapy. This recommendation is based on the most recent and highest quality study available, which prioritizes morbidity, mortality, and quality of life as the outcome 1. The treatment options for oral thrush include:
- Topical antifungal treatments like nystatin suspension or clotrimazole troches for mild cases
- Oral fluconazole for more severe or persistent cases
- Itraconazole solution as an alternative to fluconazole Key considerations during treatment include:
- Maintaining good oral hygiene by brushing teeth twice daily and cleaning dentures thoroughly if worn
- Addressing underlying conditions that may contribute to thrush, such as uncontrolled diabetes or immunosuppression
- Monitoring for treatment failure, defined as signs and symptoms of oropharyngeal or esophageal candidiasis that persist after more than 7-14 days of appropriate therapy 1. In cases of treatment failure, alternative treatments such as itraconazole solution or posaconazole immediate-release oral suspension may be effective 1.
From the FDA Drug Label
Nystatin Oral Suspension, USP, is indicated for the treatment of candidiasis in the oral cavity. The treatment for oral thrush is nystatin (PO), as it is indicated for the treatment of candidiasis in the oral cavity 2.
- Key points:
- Nystatin Oral Suspension, USP, is used to treat oral candidiasis.
- The drug label directly supports the use of nystatin for this condition.
From the Research
Treatment Options for Oral Thrush
The treatment for oral thrush typically involves antifungal medications. Some of the commonly used treatments include:
- Fluconazole tablets or suspension
- Clotrimazole troches
- Nystatin oral suspension
Efficacy of Treatment Options
Studies have shown that fluconazole is an effective treatment for oral thrush in various patient populations, including:
- HIV-infected patients 3
- Immunocompromised children 4
- Hospice and palliative medicine patients 5
- Infants 6
Comparison of Treatment Options
Comparative studies have shown that:
- Fluconazole is superior to clotrimazole troches in terms of clinical cure and patient compliance 3
- Fluconazole suspension is more effective than nystatin in the treatment of thrush in immunocompromised children 4
- Fluconazole is superior to nystatin oral suspension for the treatment of oral thrush in otherwise healthy infants 6
Administration and Dosage
The administration and dosage of fluconazole vary depending on the patient population and the specific formulation used. For example: