What is the treatment for oral thrush?

Treatment of Oral Thrush

For oral thrush treatment, fluconazole is recommended at 200 mg on the first day, followed by 100 mg once daily for 7-14 days, as it provides excellent systemic absorption and high cure rates. 1

First-Line Treatment Options

Topical Antifungal Agents

• Nystatin oral suspension - FDA-approved for oral candidiasis 2

  • Apply 4 times daily after meals for 7-14 days
  • Continue for 48 hours after symptoms resolve
  • Less effective than fluconazole (32% vs 100% cure rate in infants) 3

• Clotrimazole troches - Dissolve one 10 mg troche in mouth 5 times daily for 14 days 4

  • Provides localized antifungal activity
  • Maintains salivary levels above minimum inhibitory concentrations for most Candida strains

Systemic Antifungal Agents

• Fluconazole - Preferred for moderate to severe cases 1, 5
  • Standard regimen: 200 mg on day 1, then 100 mg daily for 7-14 days
  • Single-dose option: 150 mg once (96.5% improvement in palliative care patients) 6
  • Superior to nystatin in clinical trials 3

Treatment Algorithm Based on Severity

Mild Cases

1. Topical therapy with nystatin suspension or clotrimazole troches
2. Maintain good oral hygiene with chlorhexidine 0.2% rinses
3. Assess response within 3-5 days

Moderate to Severe Cases

1. Oral fluconazole (200 mg first day, then 100 mg daily for 7-14 days)
2. For patients unable to swallow: IV fluconazole (400 mg loading dose, then 200-400 mg daily)
3. Alternative options:
   • Itraconazole solution (200 mg once daily)
   • Posaconazole suspension (400 mg twice daily for 3 days, then 400 mg daily)
   • Voriconazole (200 mg twice daily)

Refractory Cases

1. Intravenous echinocandins (caspofungin, micafungin, or anidulafungin)
2. Amphotericin B deoxycholate for severe, resistant cases
3. Consider underlying factors contributing to treatment failure

Special Considerations

Immunocompromised Patients

• Prefer systemic therapy (fluconazole) over topical agents 1
• Longer treatment duration may be necessary
• Consider maintenance therapy for recurrent infections
• For HIV/AIDS patients, initiate antiretroviral therapy 1

Recurrent Infections

• Chronic suppressive therapy with fluconazole 100 mg three times weekly 1
• Address underlying risk factors:
  • Uncontrolled diabetes
  • Immunosuppression
  • Poor oral hygiene
  • Ill-fitting dentures 7

Prevention Measures

• Regular oral care with chlorhexidine 0.2% solution
• Daily cleaning of dentures
• Regular inspection of oral mucosa
• Avoid unnecessary antibiotics when possible
• Maintain good glycemic control in diabetic patients

Monitoring

• Assess clinical response within 3-5 days of treatment initiation 1
• Monitor liver function tests if azole treatment extends beyond 7-10 days
• Continue treatment for at least 48 hours after symptom resolution

Oral thrush is typically diagnosed clinically by the presence of characteristic white patches on oral mucosa that can be scraped off, revealing an erythematous base 8, 9. Prompt treatment with appropriate antifungal therapy based on severity leads to excellent outcomes in most patients.