Is steroid use indicated in oral candidiasis (Oral Thrush) with tonsillar hypertrophy (Enlarged Tonsils)?

From the Guidelines

Steroid use is generally not recommended for oral thrush with enlarged tonsils, as it can exacerbate fungal infections by suppressing the immune system, making it harder for the body to fight off the infection 1.

Treatment Options

• Antifungal medications are the primary treatment for oral thrush, with options including:
  • Topical azoles (clotrimazole troches) 1
  • Oral azoles (fluconazole, ketoconazole, or itraconazole solution) 1
  • Oral polyenes (nystatin suspension) 1
• For moderate to severe disease, oral fluconazole at a dosage of 100-200 mg daily for 7-14 days is recommended 1
• For fluconazole-refractory disease, itraconazole solution or posaconazole suspension may be used 1

Considerations for Enlarged Tonsils

• Enlarged tonsils may be a symptom of an underlying condition that needs to be addressed separately, and steroid use may mask the symptoms without treating the underlying cause
• Evaluation and treatment of the underlying cause of enlarged tonsils, such as bacterial infections, may be necessary

Evidence-Based Recommendations

• The Infectious Diseases Society of America recommends against the use of steroids for oral thrush, and instead recommends antifungal medications as the primary treatment 1
• The ESCMID guideline for the diagnosis and management of Candida diseases recommends fluconazole, itraconazole solution, or posaconazole as treatment options for oropharyngeal candidiasis 1

From the Research

Steroid Use in Oral Candidiasis with Tonsillar Hypertrophy

• There is no direct evidence to suggest that steroid use is indicated in oral candidiasis (Oral Thrush) with tonsillar hypertrophy (Enlarged Tonsils) 2, 3, 4, 5, 6.
• However, it is noted that inhaled steroids are a common risk factor for developing oral candidiasis, particularly in patients with a history of asthma or other respiratory conditions 3, 5, 6.
• The use of oral antifungals is generally effective in treating oral candidiasis, including cases associated with inhaled steroid use 3, 6.
• In some cases, oral candidiasis may be a symptom of an underlying systemic disease, and treatment should be tailored to the individual patient's needs 2, 4.
• Tonsillar hypertrophy is not specifically addressed in the provided studies, and its relationship to oral candidiasis and steroid use is unclear.
• The provided studies suggest that oral candidiasis is a common infection that can be effectively treated with antifungal medications, and that steroid use may be a contributing factor in some cases 2, 3, 4, 5, 6.