From the Guidelines
Oral thrush is best treated with antifungal medications, with fluconazole being the preferred treatment due to its effectiveness and convenience, as recommended by the most recent guidelines 1.
Treatment Options
- For mild disease, topical antifungals like nystatin suspension or clotrimazole troches are effective first-line treatments, as suggested by the Infectious Diseases Society of America guidelines 1.
- For moderate to severe disease, oral fluconazole at a dosage of 100–200 mg daily for 7–14 days is recommended, as it is considered the drug of choice due to its effectiveness and convenience 1.
- For fluconazole-refractory disease, alternative treatments such as itraconazole solution or posaconazole suspension may be considered, as outlined in the guidelines 1.
Additional Recommendations
- Patients should maintain good oral hygiene by brushing teeth twice daily and cleaning dentures thoroughly if worn.
- Dentures should be removed at night and soaked in antifungal solution.
- Addressing underlying causes is crucial, including controlling diabetes, avoiding unnecessary antibiotics, and limiting corticosteroid inhaler use by rinsing the mouth after use.
- Treatment should continue for at least 48 hours after symptoms resolve to prevent recurrence, as thrush can recur if the underlying causes are not addressed.
Key Considerations
- The treatment of oral thrush should prioritize the use of antifungal medications, with fluconazole being the preferred treatment due to its effectiveness and convenience.
- The guidelines from the Infectious Diseases Society of America and the Centers for Disease Control and Prevention provide recommendations for the treatment of oral thrush, including the use of topical antifungals and systemic therapy with fluconazole 1.
From the FDA Drug Label
Nystatin Oral Suspension, USP, is indicated for the treatment of candidiasis in the oral cavity. The recommended dosage of SPORANOX ® (itraconazole) Oral Solution for oropharyngeal candidiasis is 200 mg (20 mL) daily for 1 to 2 weeks.
- Treatment options for oral thrush (candidiasis) include:
- Nystatin (PO)
- Itraconazole (PO) Oral Solution
- Dosage:
From the Research
Treatment Options for Oral Candidiasis (Thrush)
- Nystatin and miconazole are the most commonly used topical antifungal drugs for treating oral candidiasis, as stated in 3.
- Both antifungal drugs are very effective but need a long time of use to eradicate the infection, according to 3.
- Miconazole gel has been shown to be significantly superior to nystatin suspension in treating oropharyngeal candidiasis in immunocompetent infants, as demonstrated in 4.
- Nystatin pastille was found to be significantly superior to placebo in treating denture stomatitis, while nystatin suspension was not superior to fluconazole in treating oral candidiasis in infants, children, or HIV/AIDS patients, as reported in 5.
Systemic Treatment Alternatives
- Oral fluconazole is effective in treating oral candidiasis that does not respond to topical treatment, as mentioned in 3.
- Other systemic treatment alternatives, such as itraconazole, voriconazole, or posaconazole, are less commonly used, according to 3.
- Echinocandins (anidulafungin, caspofungin) and isavuconazole are available as novel treatment options, as stated in 3 and 6.
Efficacy and Safety of Nystatin
- Nystatin pastille was found to be equally effective as photodynamic therapy for the clinical remission of denture stomatitis and reduction of Candida species, as reported in 7.
- The efficacy of nystatin can be increased by using it in combination with other antifungal agents or by prolonging the treatment duration, as suggested in 5.
- Poor taste and gastrointestinal adverse reactions are the most common adverse effects of nystatin, according to 5.