What is the treatment for a tongue infection?

Treatment of Tongue Infections

For most tongue infections, nystatin suspension (100,000 U/mL, 4-6 mL four times daily for 7-14 days) is the recommended first-line treatment, with fluconazole (100-200 mg daily for 7-14 days) reserved for moderate to severe cases. 1

Types of Tongue Infections and Their Treatment

Candidiasis (Most Common Tongue Infection)

Mild to Moderate Oral Candidiasis:

• First-line topical options:
  • Nystatin suspension: 100,000 U/mL, 4-6 mL four times daily for 7-14 days (place half in each side of mouth and retain as long as possible before swallowing) 1
  • Nystatin pastilles: 1-2 pastilles (200,000 U each) 4 times daily for 7-14 days 1
  • Clotrimazole troches: 10 mg 5 times daily for 7-14 days 1, 2
  • Miconazole mucoadhesive buccal tablets: 50 mg once daily for 7-14 days 1

Moderate to Severe or Refractory Oral Candidiasis:

• Systemic options:
  • Fluconazole: 100-200 mg daily for 7-14 days 1, 2
  • Itraconazole solution: 200 mg daily for 7-14 days (particularly for fluconazole-refractory cases) 1, 2
  • For severe refractory cases: Echinocandins or amphotericin B may be considered 1

Tongue Abscess (Rare but Serious)

• Immediate interventions:

  • Intravenous antibiotics (broad-spectrum covering oral flora) 3, 4, 5
  • Needle aspiration of abscess through inferior surface of tongue (preferred over incision and drainage) 5
  • Close monitoring for potential airway compromise 4
  • Consider CT imaging for diagnosis and to determine extent 5

• Risk factors to assess:

  • Immunocompromised status (significantly increases risk) 4
  • Direct trauma to tongue 4

Special Considerations

For Specific Tongue Conditions:

• Median rhomboid glossitis: Typically associated with candidal infection; treat with topical antifungals 6, 7

• Atrophic glossitis: Identify and treat underlying nutritional deficiency (iron, folic acid, vitamin B12, riboflavin, or niacin) 6, 7

• Oral hairy leukoplakia: Caused by Epstein-Barr virus; treat with oral antivirals, especially in immunocompromised patients 6, 7

Prevention of Recurrent Candidal Infections:

• Maintain good oral hygiene
• Remove and clean dentures daily
• Rinse mouth after using inhaled corticosteroids
• Avoid unnecessary antibiotics
• Control underlying conditions (diabetes, etc.) 1

Monitoring and Follow-up

• Evaluate clinical response within 3-5 days of treatment initiation 1
• Monitor liver function tests if treatment extends beyond 7-10 days 1
• Immunocompromised patients may require longer treatment durations and maintenance therapy 1

When to Refer

• Tongue growths or lesions of unclear etiology (may require biopsy) 6, 7
• Severe infections with risk of airway compromise 4
• Non-response to standard therapy after 7-14 days 1

Remember that while candidiasis is the most common tongue infection, other conditions like abscesses, though rare, can be life-threatening and require prompt diagnosis and treatment, especially in immunocompromised patients.