Treatment of Oral Thrush
For oral thrush treatment, clotrimazole troches 10 mg 5 times daily for 7-14 days are recommended as first-line therapy for mild disease, while oral fluconazole 100-200 mg daily for 7-14 days is recommended for moderate to severe disease. 1
Treatment Based on Disease Severity
Mild Oral Thrush
- Clotrimazole troches, 10 mg 5 times daily for 7-14 days (first-line therapy) 2, 1
- Miconazole mucoadhesive buccal 50-mg tablet applied to the mucosal surface over the canine fossa once daily for 7-14 days (alternative first-line therapy) 2, 1
- Nystatin suspension (100,000 U/mL) 4-6 mL 4 times daily for 7-14 days (alternative therapy) 2, 3
- Nystatin pastilles (200,000 U each) 1-2 pastilles 4 times daily for 7-14 days (alternative therapy) 2
Moderate to Severe Oral Thrush
- Oral fluconazole, 100-200 mg daily for 7-14 days (first-line therapy) 2, 1
- A single-dose fluconazole 150 mg has shown 96.5% improvement in signs and symptoms in palliative care patients, offering a reduced pill burden option 4
Fluconazole-Refractory Disease
- Itraconazole solution, 200 mg once daily for up to 28 days 2, 1
- Posaconazole suspension, 400 mg twice daily for 3 days then 400 mg daily for up to 28 days 2, 1
- Voriconazole, 200 mg twice daily 2, 1
- Amphotericin B deoxycholate oral suspension, 100 mg/mL 4 times daily 2, 1
- For severe refractory cases, intravenous options include: 2
- Echinocandins (caspofungin: 70-mg loading dose, then 50 mg daily; micafungin: 100 mg daily; or anidulafungin: 200-mg loading dose, then 100 mg daily)
- Amphotericin B deoxycholate, 0.3 mg/kg daily
Special Considerations
Denture-Related Candidiasis
- Disinfection of the denture in addition to antifungal therapy is essential 2, 1
- Removing dentures at night and cleaning thoroughly improves treatment outcomes 1
Immunocompromised Patients
- HIV-infected patients should receive antiretroviral therapy to reduce recurrent infections 2, 1
- Immunocompromised patients may require longer treatment courses or higher doses of antifungal medications 1, 5
- Systemic therapy with itraconazole oral solution has shown greater efficacy than clotrimazole troches in immunocompromised patients (60% vs 32% negative cultures) 5
Recurrent Oral Thrush
- For chronic suppressive therapy in recurrent cases, fluconazole 100 mg three times weekly is recommended 2, 1
- Investigate underlying causes for persistent thrush, as it may indicate immunodeficiency or other conditions 6, 7
Treatment Efficacy Considerations
- Fluconazole tablets once daily have shown better patient compliance compared to clotrimazole troches five times daily 8
- Clotrimazole provides localized antifungal action with concentrations that inhibit most Candida species persisting in saliva for up to three hours 9
- Treatment should continue until clinical resolution of symptoms 1