From the Guidelines
Oropharyngeal candidiasis is typically treated with oral fluconazole 100-200 mg daily for 7-14 days as first-line therapy, as it is as effective as, and in some studies, superior to topical therapy 1. The treatment of oropharyngeal candidiasis (thrush) depends on the severity of the infection and the patient's immune status.
- For mild cases, topical antifungal medications such as clotrimazole troches (10 mg) dissolved in the mouth 5 times daily for 7-14 days or nystatin suspension (100,000 units/mL) 4-6 mL swished and swallowed 4 times daily for 7-14 days are effective options 1.
- For more severe cases or when topical therapy fails, oral fluconazole is recommended, with a dosage of 100-200 mg daily for 7-14 days 1.
- Patients with HIV or immunosuppression may require longer treatment courses and possibly maintenance therapy, with fluconazole 100-200 mg 3 times a week being a recommended regimen for suppressive therapy 1.
- For fluconazole-resistant cases, alternatives include itraconazole oral solution 200 mg daily for 7-14 days or posaconazole 400 mg twice daily for 3 days, then 400 mg daily for up to 28 days 1. Alongside medication, good oral hygiene is essential, including regular brushing, flossing, and cleaning dentures if applicable. Patients should avoid smoking and limit sugar intake during treatment. These medications work by disrupting the fungal cell membrane (azoles) or binding to ergosterol in the membrane (polyenes like nystatin), ultimately preventing fungal growth and reproduction. Most patients respond well to treatment within 7-14 days, but recurrence is common in immunocompromised individuals.
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. The solution should be vigorously swished in the mouth (10 mL at a time) for several seconds and swallowed. For patients with oropharyngeal candidiasis unresponsive/refractory to treatment with fluconazole tablets, the recommended dose is 100 mg (10 mL) b.i.d.
The treatment for oropharyngeal candidiasis (Thrush) is itraconazole oral solution with a recommended dosage of 200 mg (20 mL) daily for 1 to 2 weeks. Alternatively, for patients unresponsive to fluconazole, the dose is 100 mg (10 mL) twice a day. Another option is clotrimazole troches, as indicated in the label for the local treatment of oropharyngeal candidiasis 2, 2, 3.
From the Research
Treatment Options for Oropharyngeal Candidiasis
The treatment for oropharyngeal candidiasis (Thrush) typically involves the use of antifungal agents. The following are some of the treatment options:
- Topical antifungal agents such as amphotericin B or nystatin, imidazoles like clotrimazole or miconazole 4
- Systemic antifungal agents like fluconazole, itraconazole, voriconazole, or posaconazole, which are generally safe and effective in HIV-infected patients with oropharyngeal candidiasis 5, 6
- Itraconazole oral solution, which has been shown to be effective in treating oropharyngeal candidosis, with a clinical and mycological response rate of 100% within 1 week of treatment 7
- Fluconazole capsules, which have been compared to itraconazole oral solution in a double-blind trial and found to be equally effective in treating oropharyngeal candidiasis in patients with AIDS 8
Considerations for Treatment
When treating oropharyngeal candidiasis, it is essential to consider the following:
- The degree of immunosuppression, as relapse is more common in patients with severe immunosuppression 5, 6
- The presence of other superficial sites of infection, which should be looked for and treated accordingly 4
- The potential for drug interactions and side effects, which should be monitored closely 5, 6, 8