From the Guidelines
Thrush should be treated with antifungal medications, with fluconazole being a highly effective option for both oral and vaginal thrush, as supported by the Infectious Diseases Society of America's 2016 clinical practice guideline 1. When it comes to treating thrush, the goal is to reduce morbidity, mortality, and improve quality of life.
- For oral thrush, treatment options include nystatin oral suspension, clotrimazole troches, or fluconazole.
- For vaginal thrush, over-the-counter options like clotrimazole or miconazole creams or suppositories can be used, or a single oral dose of fluconazole 150 mg, which is recommended for recurring vulvovaginal candidiasis, followed by fluconazole 150 mg weekly for 6 months 1. Key considerations during treatment include:
- Maintaining good oral hygiene
- Rinsing with salt water
- Avoiding irritants like spicy foods or alcohol
- Removing and thoroughly cleaning dentures nightly for denture wearers It's essential to address underlying conditions that may be contributing to the development of thrush, such as antibiotic use, immune suppression, or diabetes, to prevent recurrence. In terms of specific treatment regimens, fluconazole 150 mg weekly for 6 months is recommended for recurring vulvovaginal candidiasis, following 10-14 days of induction therapy with a topical agent or oral fluconazole 1.
From the Research
Treatment Options for Thrush
- Topical antifungal agents are generally used for the treatment of superficial fungal infections, including thrush, unless the infection is widespread or resistant to initial therapy 2.
- Systemic antifungals, such as fluconazole, are often reserved for the treatment of systemic candidiasis and other invasive fungal infections 2.
- For oral thrush, fluconazole has been shown to be superior to nystatin suspension in otherwise healthy infants, with a clinical cure rate of 100% compared to 32% for nystatin 3.
- A single-dose of fluconazole (150 mg) has also been shown 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 4.
Treatment for Vaginal Candidiasis (Thrush)
- Topical imidazole appears to be more effective than nystatin for treating symptomatic vaginal candidiasis in pregnancy 5.
- Treatments for seven days may be necessary in pregnancy, rather than the shorter courses more commonly used in non-pregnant women 5.
- Oral itraconazole and oral fluconazole have been shown to be effective in treating vaginal candidiasis, with eradication rates of 80% and 76%, respectively, at short-term assessment 6.
- Intravaginal clotrimazole has also been shown to be effective, but with lower eradication rates (72% at short-term assessment) compared to oral itraconazole and fluconazole 6.