From the Guidelines
Oropharyngeal candidiasis, also known as thrush, should be treated with antifungal medications, with fluconazole being the preferred treatment for moderate to severe infections, at a dosage of 200 mg on day one followed by 100 mg daily for 7-14 days, as recommended by the most recent and highest quality study 1.
Symptoms of Oropharyngeal Candidiasis
The symptoms of oropharyngeal candidiasis include white patches on the tongue and inside of the mouth, redness and soreness in the mouth, difficulty swallowing, and a cottony feeling in the mouth.
Treatment Options
- For mild cases, clotrimazole troches (10 mg) dissolved in the mouth five times daily for 7-14 days, or nystatin suspension (100,000 units/mL) with 4-6 mL swished and swallowed four times daily for 7-14 days can be used 1.
- For moderate to severe infections, oral fluconazole is recommended, with a dosage of 200 mg on day one followed by 100 mg daily for 7-14 days 1.
- For fluconazole-refractory disease, itraconazole solution or posaconazole suspension can be used as alternative treatments 1.
Additional Recommendations
- Maintain good oral hygiene by brushing teeth twice daily and rinsing with warm saltwater.
- Avoid sugary foods and drinks which can worsen the infection.
- If you use inhalers, rinse your mouth after each use to prevent reinfection.
- Complete the full treatment course to prevent recurrence.
- If symptoms persist beyond two weeks of treatment or you have a weakened immune system, seek medical attention as you may need stronger antifungal therapy or evaluation for underlying conditions.
Key Considerations
- The treatment of oropharyngeal candidiasis should be guided by the severity of the infection and the patient's immune status.
- Antiretroviral therapy should be used whenever possible for HIV-infected patients with oropharyngeal or esophageal candidiasis 1.
- Chronic suppressive therapy with fluconazole may be necessary for patients with persistent immunosuppression 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 Patients with AIDS and cryptococcal meningitis or recurrent oropharyngeal candidiasis usually require maintenance therapy to prevent relapse
The symptoms of oropharyngeal candidiasis (thrush) are not explicitly stated in the provided drug labels. The treatment option for oropharyngeal candidiasis is fluconazole with a recommended dosage of 200 mg on the first day, followed by 100 mg once daily for at least 2 weeks 2. Maintenance therapy may be required for patients with AIDS and recurrent oropharyngeal candidiasis to prevent relapse 2. In pediatric patients, fluconazole has been shown to be effective in treating oropharyngeal candidiasis, with clinical cure rates of 86% and mycological eradication rates of 76% 2.
From the Research
Symptoms of Oropharyngeal Candidiasis (Thrush)
- Oropharyngeal candidiasis is a common opportunistic infection that presents different acute and chronic clinical presentations 3, 4
- Symptoms can range from superficial mucocutaneous overgrowths to invasive bloodstream infections with a high mortality rate 4
- Candidiasis is associated with immunosuppression, diabetes, broad-spectrum antibiotics, and corticosteroid use 5
Treatment Options for Oropharyngeal Candidiasis (Thrush)
- Topical antifungal drugs such as nystatin and miconazole are commonly used to treat oral candidiasis 3
- Other topical alternatives include amphotericin B, clotrimazole, and fluconazole 3, 4
- Systemic treatment alternatives include oral fluconazole, itraconazole, voriconazole, and posaconazole 3, 4
- Novel approaches in antifungal therapy include the use of probiotics, echinocandins, and isavuconazole 3, 4
- Weekly fluconazole prophylaxis has been shown to be effective in preventing oropharyngeal and vaginal candidiasis in women with HIV infection 6
Antifungal Agents and Their Uses
- Polyenes (nystatin, amphotericin B) are effective against oral candidiasis, but may have adverse effects and drug interactions 4
- Azoles (ketoconazole, miconazole, clotrimazole, fluconazole, itraconazole, voriconazole, posaconazole, isavuconazole) are widely used to treat candidiasis, but may have varying degrees of efficacy and safety 4
- Echinocandins (caspofungin, micafungin, anidulafungin) are effective against systemic candidiasis, but may only be used intravenously 3, 4