What is the treatment for oral candidiasis (thrush) on the lip?

Treatment for Oral Candidiasis on the Lip

For oral candidiasis affecting the lip, topical antifungal agents such as clotrimazole troches (10 mg 5 times daily) or miconazole mucoadhesive buccal tablets (50 mg once daily) for 7-14 days are recommended as first-line treatment. 1

Treatment Algorithm Based on Severity

Mild Disease

• First-line options:

  • Clotrimazole troches: 10 mg 5 times daily for 7-14 days 1
  • Miconazole mucoadhesive buccal tablet: 50 mg applied to the mucosal surface once daily for 7-14 days 1

• Alternative options:

  • Nystatin suspension: 100,000 U/mL, 4-6 mL 4 times daily for 7-14 days 1
  • Nystatin pastilles: 1-2 pastilles (200,000 U each) 4 times daily for 7-14 days 1

Moderate to Severe Disease

• Oral fluconazole: 100-200 mg daily for 7-14 days 1, 2

Fluconazole-Refractory Disease

• First-line options:

  • Itraconazole solution: 200 mg once daily for up to 28 days 1, 3
  • Posaconazole suspension: 400 mg twice daily for 3 days, then 400 mg daily 1

• Alternative options:

  • Voriconazole: 200 mg twice daily 1
  • Amphotericin B deoxycholate oral suspension: 100 mg/mL 4 times daily 1

Special Considerations

For Denture-Related Candidiasis

Disinfection of dentures is essential in addition to antifungal therapy 1, 2. Remove dentures at night and clean thoroughly with appropriate denture cleaners.

For HIV-Infected Patients

Antiretroviral therapy is strongly recommended to reduce the incidence of recurrent infections 1, 2.

For Recurrent Infections

If chronic suppressive therapy is required, fluconazole 100 mg three times weekly is recommended 1, 2.

Administration Tips for Topical Agents

• For troches: Allow to dissolve slowly in the mouth, ensuring contact with the affected area
• For suspensions: Swish thoroughly in mouth for several seconds before swallowing
• For miconazole buccal tablets: Apply to the canine fossa (upper gum) and allow to dissolve

Important Caveats

1. Resistance concerns: Prolonged or repeated courses of fluconazole may lead to resistance, particularly in immunocompromised patients 2

2. Treatment failure: If no improvement is seen within 2 weeks, consider:

   • Non-compliance with medication
   • Incorrect diagnosis
   • Resistant Candida species
   • Underlying immunosuppression

3. Systemic spread: In immunocompromised patients, monitor for signs of esophageal or systemic candidiasis, which require more aggressive treatment 1

4. Drug interactions: Be aware that azole antifungals (especially systemic) may interact with other medications 4

5. Duration of therapy: Continue treatment for at least 48 hours after symptoms resolve to prevent recurrence 2, 4