What is the treatment for thrush?

Treatment of Oral Thrush

Fluconazole is the first-line treatment for oral thrush, with a recommended dose of 100-200 mg daily for 7-14 days. 1

First-Line Treatment Options

Systemic Antifungal Therapy

• Fluconazole (oral): 100-200 mg daily for 7-14 days 1
  • For hospice and palliative care patients: A single 150 mg dose may be effective (96.5% of patients showed >50% improvement) 2
  • Requires dose adjustment in renal impairment (50% reduction if creatinine clearance <50 mL/min) 1

Topical Antifungal Options

• Clotrimazole troches: Dissolve in mouth for approximately 30 minutes; effective concentrations persist in saliva for up to 3 hours 1, 3
• Miconazole mucoadhesive buccal tablet 1
• Nystatin suspension: Swish and swallow multiple times daily 1

Treatment Duration and Monitoring

• Treatment should continue for at least 7-14 days and for at least 48 hours after symptom resolution 1
• Clinical response should be assessed within 3-5 days of treatment initiation 1
• Monitor liver function tests if treatment extends beyond 7-10 days 1
• Typical improvement occurs within 48-72 hours, with complete resolution within 7-14 days 1

Alternative Treatment Options

If first-line therapy fails or in special circumstances:

• Alternative oral agents:

  • 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

• For azole-resistant cases: Topical amphotericin B suspension (100 mg swish-and-spit 4 times daily) may be effective 4

Special Populations

Immunocompromised Patients

• HIV/AIDS patients may require longer treatment durations and maintenance therapy 1
• Systemic therapy often preferred over topical agents 1
• For recurrent infections in immunocompromised patients, chronic suppressive therapy with fluconazole 100-200 mg three times weekly is recommended 1, 5

Pregnant Women

• Topical imidazoles are more effective than nystatin for treating vaginal candidiasis in pregnancy 6
• Seven-day treatment courses are more effective than shorter courses during pregnancy 6

Prevention and Patient Education

• Good oral hygiene practices are essential:
  • Remove and clean dentures daily 1
  • Avoid unnecessary antibiotics 1
  • Rinse mouth after using inhaled corticosteroids 1

Treatment Failure Considerations

If no improvement is seen after 7 days, consider:

• Alternative diagnoses
• Resistant Candida species
• Need for longer treatment duration
• Alternative antifungal agents 1

Common Pitfalls to Avoid

1. Inadequate treatment duration: Ensure complete course even if symptoms improve
2. Failure to adjust dose in renal impairment: Reduce fluconazole dose by 50% if creatinine clearance <50 mL/min
3. Missing resistant strains: Consider culture and susceptibility testing if initial therapy fails
4. Overlooking underlying conditions: Address predisposing factors like immunosuppression, diabetes, or antibiotic use
5. Neglecting oral hygiene: Patient education on proper oral care is essential for prevention of recurrence