From the Guidelines
Oral thrush is best treated with oral fluconazole at a dosage of 100–200 mg daily for 7–14 days, as it is considered the drug of choice due to its effectiveness and convenience. For mild disease, alternative options include clotrimazole troches at a dosage of 10 mg 5 times daily or nystatin suspension at a concentration of 100,000 U/mL and a dosage of 4–6 mL 4 times daily for 7–14 days 1. However, oral fluconazole is preferred due to its superior efficacy and better tolerability compared to topical therapy 1. It is essential to maintain good oral hygiene during treatment by brushing teeth twice daily and cleaning dentures thoroughly if worn. For denture wearers, removing dentures at night and soaking them in an antifungal solution can help prevent recurrence.
Some key considerations in the treatment of oral thrush include:
- The severity of the disease, with mild cases potentially being managed with topical agents and more severe cases requiring oral fluconazole
- The potential for fluconazole-refractory disease, which may require alternative treatments such as itraconazole or posaconazole 1
- The importance of addressing underlying conditions, such as diabetes or immune disorders, that may be contributing to the development of oral thrush
- The need for chronic suppressive therapy in certain cases, such as in patients with HIV infection, which can be effectively managed with fluconazole 100 mg 3 times weekly 1
Overall, the treatment of oral thrush should be guided by the severity of the disease, the presence of underlying conditions, and the potential for treatment resistance, with oral fluconazole being the preferred treatment option due to its efficacy and convenience 1.
From the FDA Drug Label
Nystatin Oral Suspension, USP, is indicated for the treatment of candidiasis in the oral cavity. The recommended dosage of SPORANOX ® (itraconazole) Oral Solution for oropharyngeal candidiasis is 200 mg (20 mL) daily for 1 to 2 weeks.
The treatment for oral candidiasis (Oral Thrush) includes:
- Nystatin Oral Suspension 2
- Itraconazole Oral Solution, with a recommended dosage of 200 mg (20 mL) daily for 1 to 2 weeks 3
From the Research
Treatment Options for Oral Candidiasis
The treatment for oral candidiasis, also known as oral thrush, can vary depending on the severity of the infection and the patient's overall health.
- Topical antifungal agents such as nystatin, miconazole, and clotrimazole are commonly used to treat oral candidiasis 4, 5, 6.
- Systemic antifungal agents like fluconazole can be used to treat oral candidiasis that does not respond to topical treatment or in cases where the patient has a weakened immune system 7, 8, 5.
- Other systemic treatment alternatives include itraconazole, voriconazole, and posaconazole, although these are less commonly used 5.
- Novel approaches to antifungal therapy, such as the use of probiotics, echinocandins, and isavuconazole, are also being explored 4, 5.
Specific Treatment Regimens
- A single dose of fluconazole 150 mg has been shown to be effective in treating oral thrush in hospice and palliative medicine patients 7.
- Fluconazole suspension has been shown to be superior to nystatin oral suspension in treating oral candidiasis in infants 8.
- Nystatin and miconazole are effective topical antifungal drugs, but may require a long treatment duration to eradicate the infection 5.
Considerations for Treatment
- The choice of treatment should take into account the patient's overall health, the severity of the infection, and any potential interactions with other medications 4, 5, 6.
- Topical antifungal agents are generally the first line of treatment, with systemic antifungal agents reserved for more severe or resistant cases 6.
- It is also important to address any underlying predisposing factors, such as poor oral hygiene or immunosuppression, to prevent recurrence of the infection 6.