From the Guidelines
Severe oral thrush is typically treated with oral fluconazole, usually starting with a 100-200mg daily dose for 7-14 days until symptoms resolve. This recommendation is based on the most recent and highest quality study available, which suggests that oral fluconazole is the preferred treatment for severe cases of oral thrush 1. The treatment guidelines recommend oral fluconazole as the first-line treatment for moderate to severe oropharyngeal candidiasis, with a dosage of 100-200mg daily for 7-14 days 1.
Some key points to consider when treating severe oral thrush include:
- Maintaining good oral hygiene by brushing teeth gently twice daily and rinsing with warm saltwater
- Removing dentures at night and cleaning them thoroughly
- Avoiding sugary foods and drinks which can worsen the infection
- Addressing any underlying conditions that may be contributing to the infection, such as uncontrolled diabetes, HIV, or corticosteroid use
Alternative treatments, such as nystatin oral suspension or clotrimazole troches, may be considered in certain cases, but oral fluconazole is generally the preferred treatment due to its efficacy and convenience 1. It is also important to note that severe thrush often indicates an underlying condition affecting immune function, so addressing any contributing factors is essential for preventing recurrence. If symptoms do not improve within a week of treatment, follow-up with a healthcare provider is necessary to adjust medication or further evaluate the condition 1.
From the FDA Drug Label
The recommended dosage of SPORANOX ® (itraconazole) Oral Solution for oropharyngeal candidiasis is 200 mg (20 mL) daily for 1 to 2 weeks. For patients with oropharyngeal candidiasis unresponsive/refractory to treatment with fluconazole tablets, the recommended dose is 100 mg (10 mL) b.i. d.
The treatment for severe oral candidiasis (thrush) is itraconazole oral solution. The recommended dosage is:
- 200 mg (20 mL) daily for 1 to 2 weeks for initial treatment
- 100 mg (10 mL) twice daily for patients unresponsive or refractory to fluconazole treatment 2
From the Research
Treatment Options for Severe Oral Candidiasis
- The treatment for severe oral candidiasis (thrush) can include antifungal medications such as fluconazole, nystatin, and miconazole 3, 4, 5.
- Fluconazole has been shown to be effective in treating oral thrush, with a single-dose of 150 mg being effective in 96.5% of patients with advanced cancer 3.
- In infants, fluconazole suspension has been shown to be superior to nystatin oral suspension for the treatment of oral thrush, with a 100% clinical cure rate compared to 32% for nystatin 4.
- Topical antifungal drugs such as nystatin and miconazole are commonly used to treat oral candidiasis, but may require a long time to eradicate the infection 5.
- Systemic antifungal drugs such as itraconazole, voriconazole, and posaconazole may be used to treat oral candidiasis that does not respond to topical treatment 5, 6.
- Fluconazole mouthrinses have also been shown to be effective in treating oral candidiasis, with a 94% complete symptomatic and clinical relief rate in patients with oral candidiasis 7.
Antifungal Medications
- Polyenes (nystatin, amphotericin B) are a class of antifungal medications that can be used to treat oral candidiasis 5, 6.
- Azoles (ketoconazole, miconazole, clotrimazole, fluconazole, itraconazole, voriconazole, posaconazole, isavuconazole) are another class of antifungal medications that can be used to treat oral candidiasis 5, 6.
- Echinocandins (caspofungin, micafungin, anidulafungin) are a class of antifungal medications that can be used to treat oral candidiasis, but are only available for intravenous use 5, 6.