What is the treatment for thrush?

Treatment for Thrush

For oral thrush, fluconazole 100-200 mg daily for 7-14 days is the recommended first-line treatment due to its superior efficacy compared to topical agents. 1

Oral Thrush Treatment Options

First-line treatments:

• Systemic therapy:

  • Fluconazole 100-200 mg daily for 7-14 days 1
  • For severe cases: Continue until 48 hours after symptom resolution

• Topical alternatives:

  • Clotrimazole troches 1, 2
  • Miconazole mucoadhesive buccal tablet 1
  • Nystatin oral suspension (less effective than fluconazole) 1, 3

Alternative oral antifungals (for fluconazole-resistant cases):

• Itraconazole solution 200 mg once daily for up to 28 days 1
• 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

Vaginal Thrush Treatment Options

Uncomplicated vaginal candidiasis:

• Topical antifungal agents (no single agent superior to others) 4

  • Miconazole vaginal insert 5
  • Clotrimazole vaginal tablets 6, 7

• Oral therapy:

  • Single 150-mg dose of fluconazole 4
  • For severe acute cases: Fluconazole 150 mg every 72 hours for 2-3 doses 4

For C. glabrata vaginal infections (fluconazole-resistant):

1. Intravaginal boric acid 600 mg daily for 14 days 4
2. Nystatin intravaginal suppositories 100,000 units daily for 14 days 4
3. Topical 17% flucytosine cream alone or with 3% AmB cream daily for 14 days 4

Special Considerations

Recurrent infections:

• For recurring vulvovaginal candidiasis: 10-14 days induction therapy with topical agent or oral fluconazole, followed by fluconazole 150 mg weekly for 6 months 4
• For recurrent oral thrush: Consider chronic suppressive therapy with fluconazole 100-200 mg three times weekly 1

Immunocompromised patients:

• May require longer treatment duration and closer follow-up 1
• Systemic therapy often preferred over topical agents 1

Pregnancy:

• Topical imidazoles appear more effective than nystatin for vaginal candidiasis 7
• Seven-day treatment courses may be necessary rather than shorter courses 7

Treatment Monitoring

• Assess clinical response within 3-5 days of treatment initiation 1
• Monitor liver function tests if treatment extends beyond 7-10 days 1
• If no improvement after 7 days, consider:
  • Alternative diagnoses
  • Resistant Candida species
  • Need for longer treatment duration
  • Alternative antifungal agents 1

Prevention Strategies

• Good oral hygiene practices
• Remove and clean dentures daily
• Avoid unnecessary antibiotics
• Rinse mouth after using inhaled corticosteroids
• For vaginal thrush: Keep genital area cool and dry, wear cotton underwear, change out of damp clothes promptly 1, 5

The choice between topical and systemic therapy should be based on severity of infection, patient factors, and potential for drug interactions. Fluconazole has demonstrated superior efficacy compared to nystatin in multiple studies 3, 8, making it the preferred treatment for most thrush cases when systemic therapy is appropriate.