What is the best mouthwash for treating thrush?

Best Mouthwash for Treating Thrush

For treating oral thrush (candidiasis), nystatin oral suspension (100,000 units four times daily for 7-14 days) is the most effective topical antifungal mouthwash treatment. 1, 2

First-Line Topical Antifungal Options

• Nystatin oral suspension (100,000 U/mL), 4-6 mL swished in the mouth 4 times daily for 7-14 days is a highly effective first-line therapy for oral thrush 1, 2
• Clotrimazole troches (10 mg) used 5 times daily for 7-14 days is another effective first-line option for mild oropharyngeal candidiasis 1
• Miconazole mucoadhesive buccal 50-mg tablet applied to the mucosal surface once daily for 7-14 days provides an alternative first-line treatment option 1

Administration Technique for Maximum Efficacy

• For nystatin suspension, instruct patients to hold the medication in the mouth for as long as possible (at least 2 minutes) before swallowing or spitting 1
• Treatment should continue until clinical resolution of symptoms, typically requiring 7-14 days of consistent use 1
• For denture wearers with thrush, removing and disinfecting dentures in addition to antifungal therapy is essential for treatment success 1

Alternative Options for Resistant Cases

• For moderate to severe cases or those not responding to topical therapy, oral systemic therapy with fluconazole 100-200 mg daily for 7-14 days is recommended 1, 3
• Fluconazole has demonstrated superior efficacy compared to nystatin suspension in some studies, with clinical cure rates of 100% versus 32% respectively 3
• Fluconazole can also be formulated as a rinse-and-spit topical treatment (2 mg/mL aqueous solution used 3 times daily) for patients with dry mouth or difficulty swallowing 4

Treatment Considerations for Special Populations

• For recurrent infections, after initial treatment, fluconazole 100 mg three times weekly may be used as chronic suppressive therapy 1, 5
• For fluconazole-resistant cases, alternative options include itraconazole solution, posaconazole suspension, or amphotericin B deoxycholate oral suspension 1
• Treatment-resistant thrush may indicate underlying immunodeficiency or other systemic conditions requiring further investigation 6

Adjunctive Measures

• Antiseptic oral rinses like chlorhexidine digluconate 0.2% mouthwash (10 mL twice daily) can help reduce bacterial colonization of the mucosa 7
• Diluting chlorhexidine mouthwash by up to 50% can reduce the soreness that sometimes accompanies this treatment 7
• Regular oral hygiene and avoiding factors that promote fungal growth (smoking, high-sugar diet, corticosteroid inhalers) can help prevent recurrence 1

Monitoring and Follow-up

• If symptoms persist despite appropriate therapy for 14 days, reevaluation is necessary to confirm diagnosis and rule out resistant organisms 1
• Oral and lip swabs should be taken if bacterial or candidal secondary infection is suspected or if there is poor response to initial therapy 7
• The cure rate with topical antifungal agents is approximately 80-90% in patients who complete the full treatment course 1