What is the recommended treatment for mouth thrush?

Treatment for Oral Thrush (Oral Candidiasis)

For oral thrush, fluconazole 100-200 mg daily for 7-14 days is the first-line treatment, with clotrimazole troches or nystatin suspension as effective topical alternatives for initial episodes. 1

First-Line Treatment Options

Topical Antifungal Options:

1. Nystatin oral suspension

   • FDA-approved specifically for treatment of candidiasis in the oral cavity 2
   • Typical regimen: 4-6 mL (400,000-600,000 units) four times daily
   • Swish and swallow or swish and spit
   • Continue for 48 hours after symptoms resolve

2. Clotrimazole troches (lozenges)

   • Acts by altering permeability of fungal cell membranes 3
   • Dosage: 10 mg troche dissolved in mouth 5 times daily
   • Effective concentrations persist in saliva for up to 3 hours 3
   • Continue for 7-14 days

Systemic Antifungal Option:

• Fluconazole
  • 100-200 mg daily for 7-14 days 1
  • Single-dose fluconazole 150 mg has shown 96.5% efficacy in palliative care patients 4
  • Better compliance compared to multiple daily doses of topical agents 5

Treatment Selection Algorithm

1. For mild to moderate cases in immunocompetent patients:

   • Start with topical therapy (nystatin suspension or clotrimazole troches)
   • Advantages: Minimal systemic absorption, fewer drug interactions

2. For severe cases or immunocompromised patients:

   • Use systemic fluconazole 100-200 mg daily for 7-14 days 1
   • HIV/AIDS patients may require longer treatment durations and maintenance therapy 1

3. For patients with difficulty adhering to multiple daily doses:

   • Consider fluconazole for better compliance 5
   • Single-dose fluconazole 150 mg may be effective in certain populations 4

4. For fluconazole-refractory disease:

   • Extended treatment up to 28 days with options including:
     • Itraconazole solution (200 mg once daily)
     • Posaconazole suspension (400 mg twice daily for 3 days, then 400 mg daily)
     • Voriconazole (200 mg twice daily) 1

Important Clinical Considerations

• Diagnosis: Confirm diagnosis through clinical examination - look for removable white patches on erythematous base on tongue, palate, cheeks, and lips 6, 7, 8

• Denture wearers: Require thorough disinfection of dentures in addition to antifungal therapy 1

• Drug interactions: Carefully evaluate potential interactions when prescribing azole antifungals 1

• Monitoring: Assess clinical response within 3-5 days of treatment initiation 1

• Liver function: Monitor liver function tests if treatment extends beyond 7-10 days 1

Prevention Strategies

• Remove and clean dentures daily
• Rinse mouth after using inhaled corticosteroids
• Maintain good oral hygiene
• Avoid unnecessary antibiotics 1

Common Pitfalls to Avoid

1. Misdiagnosis: Oral thrush can be confused with other white lesions of the oral cavity 8

2. Inadequate treatment duration: Continuing treatment for 48 hours after symptom resolution is important to prevent recurrence

3. Ignoring underlying causes: Address predisposing factors such as immunosuppression, diabetes, or medication use

4. Neglecting denture hygiene: Failure to properly disinfect dentures can lead to treatment failure in denture wearers 1

5. Overlooking drug interactions: Azole antifungals have significant potential for drug interactions 1