What is the treatment for oral candidiasis (thrush) in adults?

From the Guidelines

For treating oral thrush in adults, fluconazole 100-200mg taken once daily for 7-14 days is typically recommended as a first-line treatment. This approach is based on the most recent and highest quality evidence available, which prioritizes morbidity, mortality, and quality of life as the primary outcomes 1. The use of fluconazole is supported by guidelines from reputable sources, including the Centers for Disease Control and Prevention (CDC) and the Infectious Diseases Society of America (IDSA) 1.

Some key points to consider when treating oral thrush in adults include:

• The importance of maintaining good oral hygiene by brushing teeth twice daily and cleaning dentures thoroughly if worn
• The need to rinse the mouth after using an inhaled corticosteroid to prevent recurrence
• The recommendation to continue treatment for at least 48 hours after symptoms resolve
• The importance of consulting a healthcare provider if symptoms persist beyond two weeks of treatment

Alternative treatment options may include:

• Topical agents such as nystatin suspension or clotrimazole troches
• Itraconazole oral solution for resistant cases However, these alternatives are generally considered secondary to fluconazole due to their lower efficacy or convenience 1.

It is essential to note that the treatment of oral thrush should be guided by the most recent and highest quality evidence available, and that the use of antifungal medications should be tailored to the individual patient's needs and circumstances 1.

From the FDA Drug Label

The use of fluconazole in children with cryptococcal meningitis, Candida esophagitis, or systemic Candida infections is supported by the efficacy shown for these indications in adults and by the results from several small noncomparative pediatric clinical studies An open-label, randomized, controlled trial has shown fluconazole to be effective in the treatment of oropharyngeal candidiasis in children 6 months to 13 years of age. In a noncomparative study of children with serious systemic fungal infections, most of which were candidemia, the effectiveness of fluconazole was similar to that reported for the treatment of candidemia in adults DOSAGE AND ADMINISTRATION Treatment of Oropharyngeal and Esophageal Candidiasis The solution should be vigorously swished in the mouth (10 mL at a time) for several seconds and swallowed. The recommended dosage of SPORANOX ® (itraconazole) Oral Solution for oropharyngeal candidiasis is 200 mg (20 mL) daily for 1 to 2 weeks.

For thrush treatment in adults, the recommended dosage is:

• Fluconazole: not explicitly stated in the label for adults, but it is effective in the treatment of oropharyngeal candidiasis in children 6 months to 13 years of age 2
• Itraconazole: 200 mg (20 mL) daily for 1 to 2 weeks for oropharyngeal candidiasis 3

From the Research

Treatment Options for Thrush in Adults

• Fluconazole tablets have been shown to be effective in treating thrush in adults, particularly those with HIV infection 4
• Clotrimazole troches are also a common treatment for thrush, but may have lower patient compliance compared to fluconazole tablets 4
• Topical therapies such as clotrimazole, nystatin, and miconazole have been found to be effective in treating cutaneous candidiasis, with similar efficacy to oral fluconazole 5
• Oral versus intra-vaginal anti-fungal treatments have been compared, with no significant difference in clinical or mycological cure rates 6

Antifungal Medications

• Fluconazole has been extensively evaluated as a treatment for candidiasis, with a cure rate of 82% in HIV-positive patients 7
• Clotrimazole troches have been found to be effective in treating oropharyngeal candidiasis, but may have lower efficacy compared to azole antifungals 7
• Nystatin has been found to be less effective than clotrimazole and azole antifungals in treating oropharyngeal candidiasis 7
• Amphotericin B has been found to be effective in azole-refractory candidiasis, but is typically reserved for severe cases 7

Treatment Considerations

• Patient compliance is an important factor in treating thrush, with fluconazole tablets having superior compliance compared to clotrimazole troches 4
• The choice of treatment may depend on the severity of the infection, as well as the patient's underlying health status and medical history 7
• Topical therapies may be effective for uncomplicated oropharyngeal candidiasis, but may not be as effective for more severe cases 7