From the Guidelines
Oral fluconazole is the preferred treatment option for oral candidiasis (thrush) due to its effectiveness, convenience, and tolerability. The treatment of oral thrush typically involves antifungal medications that target the Candida fungus causing the infection.
- For oral thrush, fluconazole is considered the drug of choice [ 1 ], with a recommended dose of 200 mg on day one followed by 100 mg daily for 7-14 days.
- Alternatively, topical therapy such as clotrimazole troches (10 mg) or nystatin suspension can be used, but oral fluconazole is as effective and, in certain studies, superior to topical therapy [ 1 ].
- It is essential to maintain good oral hygiene, avoid irritants like mouthwashes containing alcohol, and address underlying factors such as poorly controlled diabetes or immunosuppression during treatment.
- For denture wearers, removing and thoroughly cleaning dentures nightly is crucial to prevent the recurrence of thrush.
- If symptoms do not improve within a week of treatment or recur frequently, medical evaluation is necessary to rule out underlying conditions or resistant infections [ 1 ].
From the FDA Drug Label
Nystatin Oral Suspension, USP, is indicated for the treatment of candidiasis in the oral cavity. The recommended dosage of SPORANOX ® (itraconazole) Oral Solution for oropharyngeal candidiasis is 200 mg (20 mL) daily for 1 to 2 weeks.
The treatment options for oral candidiasis (thrush) include:
- Nystatin Oral Suspension 2
- Itraconazole Oral Solution 3 with a recommended dosage of 200 mg (20 mL) daily for 1 to 2 weeks.
From the Research
Treatment Options for Oral Candidiasis (Thrush)
- The treatment options for oral candidiasis include topical antifungal drugs such as nystatin and miconazole, as well as systemic treatments like fluconazole and other triazoles 4.
- Fluconazole has been shown to be effective in treating oral candidiasis in patients with HIV infection, with superior clinical cure rates and patient compliance compared to clotrimazole troches 5.
- In infants, fluconazole suspension has been found to be superior to nystatin oral suspension for the treatment of oral candidiasis, with a 100% clinical cure rate compared to 32% for nystatin 6.
- A single-dose of fluconazole 150 mg has also been shown to be effective in treating oral thrush in hospice and palliative medicine patients, with 96.5% of patients experiencing more than 50% improvement in signs and symptoms 7.
- Other treatment options include itraconazole, voriconazole, and posaconazole, as well as newer drugs like echinocandins and isavuconazole, although these may be less commonly used or available only intravenously 4.
- In cases of thrush clinically resistant to fluconazole, oral amphotericin B may be an effective alternative, with reports of improvement and clearing of symptoms in AIDS patients 8.