What is the recommended oral treatment for candida?

Oral Treatment for Candida

For oral candidiasis (thrush), fluconazole 100-200 mg daily for 7-14 days is the recommended oral treatment for moderate to severe disease. 1, 2

Treatment Options by Type of Candida Infection

Oropharyngeal Candidiasis (Thrush)

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 mucosal surface once daily for 7-14 days 1
  • Nystatin suspension: 100,000 U/mL, 4-6 mL 4 times daily for 7-14 days (swish and swallow) 1, 2
  • 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

• 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 for up to 28 days 1
• Voriconazole: 200 mg twice daily 1
• Amphotericin B deoxycholate oral suspension: 100 mg/mL 4 times daily 1

Esophageal Candidiasis

• Oral fluconazole: 200-400 mg (3-6 mg/kg) daily for 14-21 days 1
• For patients who cannot tolerate oral therapy:
  • IV fluconazole: 400 mg (6 mg/kg) daily 1
  • Echinocandins (micafungin 150 mg daily, caspofungin 70-mg loading dose then 50 mg daily, or anidulafungin 200 mg daily) 1

Vulvovaginal Candidiasis

• Single oral dose of fluconazole: 150 mg 4, 5, 6, 7
  • As effective as intravaginal preparations with better patient compliance
  • Clinical cure rates >80% in randomized studies

Urinary Tract Candidiasis

• Fluconazole-susceptible organisms: Oral fluconazole 200 mg (3 mg/kg) daily for 2 weeks 1
• Fluconazole-resistant C. glabrata: Oral flucytosine 25 mg/kg 4 times daily for 7-10 days 1

Special Considerations

Resistant Species

• For fluconazole-resistant C. glabrata:
  • Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days, or
  • Oral flucytosine 25 mg/kg 4 times daily 1
• For C. krusei: Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days 1

Immunocompromised Patients

• HIV-infected patients with oral candidiasis may require longer treatment courses 8
• For chronic suppressive therapy in recurrent infections: Fluconazole 100 mg three times weekly 2
• Antiretroviral therapy strongly recommended for HIV-infected patients to reduce recurrent infections 2

Important Clinical Pearls

• Treatment should continue for at least 48 hours after symptom resolution 2
• For denture-related candidiasis, proper denture care is essential alongside antifungal therapy 2
• Removal of predisposing factors (e.g., indwelling catheters) is strongly recommended when feasible 1
• For esophageal candidiasis, a diagnostic trial of antifungal therapy is appropriate before performing endoscopy 1
• Itraconazole oral solution should be vigorously swished in the mouth for several seconds before swallowing 3

Monitoring and Follow-up

• Schedule follow-up within 7-10 days to assess treatment response 2
• Monitor for hepatotoxicity if treatment extends beyond 7-10 days with azoles 2
• Patients with a history of recurrent candidiasis may have lower response rates and require longer treatment 7