What is the treatment for a tongue infection?

Treatment of Tongue Infections

The first-line treatment for mild oral candidiasis (the most common tongue infection) is nystatin suspension at a dosage of 4-6 mL (400,000-600,000 units) four times daily for 7-14 days. 1

Types of Tongue Infections and Their Treatment

Candidiasis (Thrush)

Candidiasis is the most common tongue infection, typically presenting as white, creamy plaque-like lesions that can be scraped off, or as erythematous patches.

Treatment options:

1. Topical antifungals (first-line for mild cases):

   • Nystatin suspension: 100,000 U/mL, 4-6 mL four times daily for 7-14 days 1
   • Clotrimazole troches: 10 mg 5 times daily for 7-14 days 1
   • Miconazole mucoadhesive buccal tablets: 50 mg once daily for 7-14 days 1
   • Nystatin pastilles: 1-2 pastilles (200,000 U each) 4 times daily for 7-14 days 1

2. Systemic antifungals (for moderate to severe cases):

   • Fluconazole: 100-200 mg daily for 7-14 days 1
   • Itraconazole solution: 200 mg daily (for refractory cases) 1

3. For severe refractory cases:

   • Echinocandins (e.g., caspofungin: 70-mg loading dose, then 50 mg daily) 1
   • Intravenous amphotericin B (for resistant cases) 1

Bacterial Tongue Abscess

Though rare, tongue abscesses can be life-threatening and require prompt treatment.

Treatment approach:

1. Antibiotics:

   • Broad-spectrum antibiotics covering oral flora 2, 3
   • Common choices include amoxicillin-clavulanate, clindamycin, or a combination of penicillin and metronidazole

2. Drainage:

   • Needle aspiration through the inferior surface of the tongue is preferred over incision and drainage 4
   • This approach minimizes edema and avoids airway compromise

3. Airway management:

   • Close monitoring for potential airway compromise, especially in immunocompromised patients 3

Median Rhomboid Glossitis

Often associated with candidal infection, presenting as a smooth, red, rhomboid-shaped area on the dorsal surface of the tongue.

Treatment:

• Topical antifungals for symptomatic lesions 5, 6
• Fluconazole for more extensive cases

Special Considerations

Immunocompromised Patients

• Require more aggressive treatment and longer duration 3
• May need maintenance therapy to prevent relapse 1
• Should be monitored closely for potential systemic spread of infection

Prevention of Recurrence

1. Oral hygiene practices:

   • Regular brushing with a soft toothbrush 7
   • Use of mild fluoride-containing, non-foaming toothpaste 7
   • Alcohol-free mouthwash rinses 7

2. Denture care:

   • Remove dentures before performing oral care 7
   • Clean dentures daily 1
   • Consider soaking dentures in antimicrobial solution 7

3. Other preventive measures:

   • Rinse mouth after using inhaled corticosteroids 1
   • Avoid unnecessary antibiotics 1
   • Control underlying conditions 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
• Consider referral to an oral and maxillofacial surgeon, otolaryngologist, or dentist experienced in oral pathology for persistent or unusual lesions 5, 6

Treatment Algorithm

1. Assess severity and type of infection
2. For mild candidal infection: Start with topical antifungals
3. For moderate to severe candidal infection: Use systemic antifungals
4. For bacterial abscess: Administer antibiotics and consider drainage
5. For immunocompromised patients: Use more aggressive treatment approach
6. For persistent symptoms: Consider biopsy to rule out malignancy

Remember that tongue infections can sometimes indicate underlying systemic conditions, particularly in cases of atrophic glossitis, which is often linked to nutritional deficiencies and resolves with correction of the underlying condition 5, 6.