From the Guidelines
Oral candidiasis (thrush) is typically treated with antifungal medications, with clotrimazole troches or nystatin suspension being recommended for mild disease, and oral fluconazole for moderate to severe disease.
Treatment Options
- For mild disease, 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 is recommended 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.
- For fluconazole-refractory disease, either itraconazole solution at a dosage of 200 mg daily or posaconazole suspension at a dosage of 400 mg twice daily for 3 days, then 400 mg daily for up to 28 days, are recommended 1.
Additional Considerations
- Chronic suppressive therapy is usually unnecessary for patients with HIV infection, but if required, fluconazole at a dosage of 100 mg 3 times weekly is recommended 1.
- Denture-related candidiasis requires disinfection of the denture, in addition to antifungal therapy 1.
- Antiretroviral therapy should be used to reduce recurrent infections in HIV-infected patients 1.
Evidence Quality
The evidence for these recommendations is based on clinical practice guidelines from the Infectious Diseases Society of America, which are considered high-quality evidence 1.
From the Research
Treatment Options for Oral Candidiasis
The treatment for oral candidiasis (thrush) can vary depending on the severity and cause of the infection. Some common treatment options include:
- Topical antifungal agents, such as nystatin and miconazole, which are effective but may require a long treatment period 2
- Single-dose fluconazole 150 mg, which has been shown to be effective in treating oral thrush in patients with advanced cancer 3
- Mechanical breakage of the biofilm in combination with topical polyenes, which can help to treat oral candidosis 4
- Systemic antifungal agents, such as itraconazole, voriconazole, or posaconazole, which can be used to treat recalcitrant infections 2
- Novel treatments, such as echinocandins (anidulafungin, caspofungin) and isavuconazole, which are available for oral and intravenous use 2
Alternative Treatment Options
Some studies have also investigated the use of herbal medicines and natural bioactive compounds as alternative treatment options for oral candidiasis. These include:
- Garlic, green tea, propolis, curcumin, licorice root, cinnamon, resveratrol, ginger, and berberine, which have been shown to have anti-candida activity 5
- Nutraceuticals, which may be a safe, accessible, and inexpensive management option for preventing and treating oral diseases 5
Important Considerations
When treating oral candidiasis, it is important to consider the following:
- The risk of developing resistant strains of Candida, particularly with the use of azoles 4
- The need for mechanical breakage of the biofilm in combination with topical polyenes to effectively treat oral candidosis 4
- The potential interactions between antifungal agents and other medications, which should be assessed before use 2