From the Guidelines
Diagnosing and treating oral candidiasis involves a clinical examination, identification of characteristic white plaques, and treatment with topical antifungal medications, with oral fluconazole being effective for more severe or resistant cases. The approach to diagnosing oral candidiasis includes a clinical examination to identify characteristic white, removable plaques on the oral mucosa, often accompanied by symptoms like a burning sensation or altered taste. Diagnosis can be confirmed through microscopic examination of scrapings with potassium hydroxide preparation or fungal culture.
Treatment Options
Treatment typically begins with topical antifungal medications such as:
- Nystatin suspension (400,000-600,000 units swished and swallowed 4-5 times daily for 7-14 days)
- Clotrimazole troches (10 mg dissolved in mouth 5 times daily for 7-14 days). For more severe or resistant cases, oral fluconazole (200 mg on day one, followed by 100 mg daily for 7-14 days) is effective 1.
Addressing Underlying Risk Factors
Addressing underlying risk factors is crucial, including:
- Improving oral hygiene
- Controlling diabetes
- Discontinuing unnecessary antibiotics
- Proper denture care (removing overnight and cleaning thoroughly)
- Addressing immunosuppression when possible. Patients should avoid alcohol-based mouthwashes during treatment as they can exacerbate symptoms.
Recurrent Infections
For recurrent infections, identifying and managing predisposing factors is essential, as oral candidiasis often indicates an underlying condition affecting immune function or oral environment. Most cases resolve within 1-2 weeks of appropriate therapy. According to the most recent guidelines, fluconazole remains the first line of therapy for both oropharyngeal candidiasis 1.
Key Considerations
Key considerations in the management of oral candidiasis include the potential for antifungal resistance, especially with prolonged use of systemically absorbed azoles, and the importance of optimizing treatment based on the specific needs and conditions of the patient, including those with HIV infection or AIDS 1.
From the FDA Drug Label
The recommended dosage of SPORANOX ® (itraconazole) Oral Solution for oropharyngeal candidiasis is 200 mg (20 mL) daily for 1 to 2 weeks. Clinical signs and symptoms of oropharyngeal candidiasis generally resolve within several days.
The approach to diagnose and treat oral candidiasis involves:
- Diagnosis: Although the provided drug labels do not directly address the diagnostic approach, diagnosis of oral candidiasis is typically based on clinical presentation and may involve physical examination and laboratory tests such as microscopy or culture.
- Treatment: The recommended treatment for oropharyngeal candidiasis is itraconazole oral solution 200 mg daily for 1 to 2 weeks 2.
- Treatment Duration: Treatment should continue until clinical signs and symptoms resolve, which is generally within several days 2.
- Dose Adjustment: For patients unresponsive to fluconazole, a dose of 100 mg b.i.d. may be used 2 2.
- Follow-up: Patients may be expected to relapse shortly after discontinuing therapy, so follow-up is necessary to monitor for recurrence 2 2.
From the Research
Diagnosis of Oral Candidiasis
- The diagnosis of oral candidiasis involves a thorough medical history, clinical examination, and sometimes laboratory tests 3.
- The clinical presentations of oral candidiasis can vary, including acute and chronic forms, with different signs and symptoms 4, 5.
- A wide range of clinical signs and symptoms can be observed, including erythematous and pseudomembranous candidosis 6.
Treatment of Oral Candidiasis
- Topical antifungal drugs, such as nystatin and miconazole, are commonly used to treat oral candidiasis 4, 6.
- Nystatin and miconazole are effective, but may require a long treatment duration to eradicate the infection 4.
- Oral fluconazole is an effective alternative for treating oral candidiasis that does not respond to topical treatment 4, 6.
- Systemic treatment alternatives, such as itraconazole, voriconazole, and posaconazole, can be used for recalcitrant infections 4.
- Newer antifungal drugs, such as echinocandins and isavuconazole, are also available for treating oral candidiasis 4.
Management and Prevention
- Understanding the signs, symptoms, and treatment of oral candidiasis is essential for effective management 7.
- Assessment and management techniques, including patient education and follow-up, are crucial for preventing relapses and improving treatment outcomes 7, 3.
- The choice of treatment should be based on the clinical presentation, patient factors, and potential interactions with other medications 4, 6.