From the Guidelines
Nystatin suspension is the recommended antifungal mouthwash for oral thrush, with a typical regimen of swishing 4-6 ml in the mouth for several minutes before swallowing or spitting it out, four times daily for 7-14 days. This recommendation is based on the most recent and highest quality study available, which is the 2016 update by the Infectious Diseases Society of America 1.
Key Points to Consider
- For mild disease, alternatives to nystatin suspension include clotrimazole troches and miconazole mucoadhesive buccal tablets, as recommended by the 2016 guideline 1.
- For moderate to severe disease, oral fluconazole is recommended, with a dosage of 100-200 mg daily for 7-14 days 1.
- It is essential to address underlying factors that may contribute to the development of oral thrush, such as antibiotic use, corticosteroid inhalers, or compromised immunity.
- For denture wearers with thrush, removing dentures at night and soaking them in an antifungal solution is also recommended, in addition to antifungal therapy 1.
Important Considerations
- The choice of antifungal agent may depend on the severity of the disease, as well as the patient's underlying health status and potential interactions with other medications.
- Topical agents, such as amphotericin B lozenges or nystatin, may not be suitable for all patients due to suboptimal tolerability and lower efficacy 1.
- The 2016 guideline recommends fluconazole as the first-line treatment for moderate to severe disease, due to its high efficacy and relatively low risk of adverse effects 1.
From the FDA Drug Label
Infants: 2 mL (200,000 units) four times daily (in infants and young children, use dropper to place one-half of dose in each side of mouth and avoid feeding for 5 to 10 minutes). Children and Adults: 4 to 6 mL (400,000 to 600,000 units) four times daily (one-half of dose in each side of mouth). The preparation should be retained in the mouth as long as possible before swallowing. 2
The recommended antifungal mouthwash for oral thrush is nystatin (PO). The dosage is:
- Infants: 2 mL (200,000 units) four times daily
- Children and Adults: 4 to 6 mL (400,000 to 600,000 units) four times daily It is essential to retain the preparation in the mouth as long as possible before swallowing.
From the Research
Antifungal Mouthwashes for Oral Thrush
There are several antifungal mouthwashes that can be used to treat oral thrush, including:
- Fluconazole: a triazole antifungal that has been shown to be effective in treating oral thrush in patients with HIV infection 3 and in hospice and palliative medicine patients 4.
- Clotrimazole: an antifungal that has been used to treat oral thrush, but has been shown to be less effective than fluconazole in some studies 3.
- Nystatin: an antifungal that has been used to treat oral thrush, but has been shown to be less effective than fluconazole in some studies 5, 6.
Recommended Antifungal Mouthwash
Based on the available evidence, fluconazole appears to be a recommended antifungal mouthwash for oral thrush, due to its high efficacy and relatively low side effect profile 3, 4, 5, 6.
- Fluconazole has been shown to be effective in treating oral thrush in a variety of patient populations, including those with HIV infection and those in hospice and palliative care.
- Fluconazole has also been shown to be superior to nystatin in treating oral thrush in some studies 5, 6.
Compounded Preparations
Compounded preparations with nystatin may also be used to treat oral thrush, particularly in cases where commercial antifungal products are not available or are too expensive 7.
- These preparations can be made in a variety of forms, including viscous oromucosal suspensions, oral/oromucosal hydrogels, and oromucosal gelatine globules.
- However, the efficacy and safety of these preparations may vary depending on the specific formulation and the patient population being treated.