From the Guidelines
Oral candidiasis should be treated with clotrimazole troches at a dosage of 10 mg 5 times daily, nystatin suspension at a concentration of 100,000 U/mL and a dosage of 4–6 mL 4 times daily, or 1–2 nystatin pastilles (200,000 U each) administered 4 times daily for 7–14 days for mild disease, as recommended by the Infectious Diseases Society of America 1. When considering treatment options, it's essential to assess the severity of the disease. For mild cases, the aforementioned treatments are effective.
- Clotrimazole troches are a suitable option, with a recommended dosage of 10 mg 5 times daily for 7–14 days 1.
- Nystatin suspension is another option, with a recommended concentration of 100,000 U/mL and a dosage of 4–6 mL 4 times daily for 7–14 days 1.
- Nystatin pastilles can also be used, with a recommended dosage of 1–2 pastilles (200,000 U each) administered 4 times daily for 7–14 days 1. For moderate to severe disease, oral fluconazole at a dosage of 100–200 mg (3 mg/kg) daily for 7–14 days is recommended 1. In cases where fluconazole is not effective, alternative treatments such as itraconazole solution or posaconazole suspension may be considered 1. It's also important to note that for denture-related candidiasis, disinfection of the denture, in addition to antifungal therapy, is recommended 1. Overall, the treatment of oral candidiasis should be guided by the severity of the disease and the patient's individual needs, with a focus on effective antifungal therapy and good oral hygiene practices.
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 (thrush) includes:
- Nystatin Oral Suspension, USP 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 (thrush) can be managed through various antifungal agents, which are available in different forms, including oral suspensions, pastilles, creams, capsules, and intravenous formulations 4, 5, 6.
- Topical Antifungal Agents: Nystatin and miconazole are the most commonly used topical antifungal drugs for treating oral candidiasis 5, 6. Other topical alternatives include amphotericin B and clotrimazole, although their availability may vary by country 5.
- Systemic Antifungal Agents: Oral fluconazole is effective in treating oral candidiasis that does not respond to topical treatment 5, 6. Other systemic treatment alternatives include itraconazole, voriconazole, and posaconazole 5, 7.
- Novel Antifungal Agents: Echinocandins, such as anidulafungin and caspofungin, can be used intravenously, while isavuconazole is available for both oral and intravenous use 5. Other new drugs, such as ibrexafungerp, and the use of antibodies, cytokines, and antimicrobial peptides, are being explored as potential treatment options 5.
- Treatment Considerations: The choice of treatment depends on the severity and type of oral candidiasis, as well as the patient's overall health and potential drug interactions 4, 5, 6. In patients with chronic or recurrent infections, or those who are immunocompromised, successful treatment may require increased dosage and extended duration of antifungal therapy 8.