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, 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 1.
Key Considerations
- The treatment approach may vary depending on the severity of the disease, with fluconazole being recommended for moderate to severe cases 1.
- For fluconazole-refractory disease, itraconazole solution or posaconazole suspension are recommended alternatives 1.
- Good oral hygiene practices, such as brushing teeth twice daily and cleaning dentures thoroughly, are essential during treatment.
- Denture wearers should remove their dentures at night and soak them in an antifungal solution to prevent recurrence.
Special Considerations
- For patients with HIV infection, chronic suppressive therapy is usually unnecessary, but if required, fluconazole at a dosage of 100 mg 3 times weekly is recommended 1.
- Treatment with HAART is also recommended to reduce recurrent infections 1.
- The choice of treatment should be guided by the severity of the disease and the patient's underlying health status, with a focus on minimizing morbidity, mortality, and improving quality of life. According to 1, oral fluconazole is considered the drug of choice due to its effectiveness and convenience.
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 as indicated for the treatment of candidiasis in the oral cavity 2
- Itraconazole Oral Solution with a recommended dosage of 200 mg (20 mL) daily for 1 to 2 weeks for oropharyngeal candidiasis 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. Some common treatment options include:
- Topical antifungal agents such as nystatin and miconazole, which are effective but may require a long treatment period 4
- Fluconazole, which has been shown to be effective in treating oral candidiasis, especially in cases that do not respond to topical treatment 5, 6, 4
- Other systemic antifungal agents such as itraconazole, voriconazole, and posaconazole, which may be used to treat more severe or recalcitrant infections 4, 7, 8
- Echinocandins, such as anidulafungin and caspofungin, which can only be used intravenously 4, 7
- Newer antifungal agents such as isavuconazole and ibrexafungerp, which may offer alternative treatment options 4, 7
Specific Treatment Regimens
Some specific treatment regimens that have been studied include:
- A single dose of fluconazole 150 mg, which has been shown to be effective in treating oral thrush in hospice and palliative medicine patients 5
- Fluconazole suspension 3 mg/kg per day for 7 days, which has been shown to be superior to nystatin oral suspension in treating oral candidiasis in infants 6
- Itraconazole 100 or 200 mg per day for 14 days, which has been shown to be effective in treating oral candidosis in various patient populations 8