From the Guidelines
Thrush is treated with antifungal medications, with the specific approach depending on the location and severity of the infection. For oral thrush, the first-line treatment is typically nystatin oral suspension (100,000 units/mL), used as a swish-and-swallow 4-5 times daily for 7-14 days 1. Alternatively, clotrimazole troches (10 mg) can be dissolved in the mouth 5 times daily. For more resistant cases, fluconazole 100-200 mg orally once daily for 7-14 days is effective.
Treatment Options
- Vaginal thrush responds well to over-the-counter treatments like clotrimazole, miconazole, or terconazole creams or suppositories used for 1-7 days depending on the formulation, or a single 150 mg oral dose of fluconazole 1.
- For skin thrush, topical antifungals like clotrimazole, miconazole, or ketoconazole creams applied twice daily for 2-4 weeks are usually sufficient. These medications work by disrupting the fungal cell membrane or inhibiting essential fungal enzymes, primarily targeting Candida species which cause thrush.
Important Considerations
- During treatment, maintaining good hygiene, avoiding irritants, and managing underlying conditions like diabetes or immunosuppression is important.
- For recurrent infections, identifying and addressing risk factors such as antibiotic use, corticosteroid inhalers, or immunocompromised states may be necessary to prevent future episodes 1.
From the FDA Drug Label
Oropharyngeal candidiasis: The recommended dosage of fluconazole tablets for oropharyngeal candidiasis is 200 mg on the first day, followed by 100 mg once daily. Clinical evidence of oropharyngeal candidiasis generally resolves within several days, but treatment should be continued for at least 2 weeks to decrease the likelihood of relapse
The treatment for thrush (oropharyngeal candidiasis) is fluconazole. The recommended dosage is:
- 200 mg on the first day
- 100 mg once daily thereafter Treatment should be continued for at least 2 weeks to decrease the likelihood of relapse 2.
From the Research
Treatment Options for Thrush
- Thrush, a fungal infection, can be treated with various antifungal medications, including nystatin, clotrimazole, miconazole, and fluconazole 3, 4, 5, 6.
- Nystatin and clotrimazole have been shown to be equivalent to miconazole in curing vaginal candidiasis, but with a higher relapse rate 3.
- Fluconazole has been found to be superior to nystatin in treating oral thrush in infants, with a clinical cure rate of 100% compared to 32% for nystatin 4.
- Miconazole has been shown to be effective in treating vaginal, skin, and nail infections caused by Candida spp. and other fungi, with higher cure rates than nystatin and amphotericin B 5.
- Single-dose fluconazole therapy has been found to be effective in treating oral thrush in hospice and palliative medicine patients, with 96.5% of patients experiencing more than 50% improvement in signs and symptoms 6.
Antifungal Medications
- Nystatin: an antifungal medication that can be used to treat oral and vaginal thrush, but may have a higher relapse rate compared to other medications 3, 4.
- Clotrimazole: an antifungal medication that can be used to treat vaginal thrush, but may have a higher relapse rate compared to miconazole 3.
- Miconazole: an antifungal medication that can be used to treat vaginal, skin, and nail infections caused by Candida spp. and other fungi, with higher cure rates than nystatin and amphotericin B 3, 5.
- Fluconazole: an antifungal medication that can be used to treat oral and vaginal thrush, with a high clinical cure rate and few side effects 4, 6.