What is the medication for oral thrush (oropharyngeal candidiasis) in an inpatient?

From the Guidelines

For oral thrush in hospitalized patients, fluconazole is the recommended first-line treatment, administered at 200 mg on the first day followed by 100 mg daily for 7-14 days, as it has been shown to be effective and well-tolerated 1.

Treatment Options

• Fluconazole is the preferred treatment due to its efficacy, convenience, and tolerability 1.
• Alternatively, nystatin oral suspension (100,000 units/mL) can be used, with 4-6 mL swished in the mouth for several minutes and then swallowed or expectorated four times daily for 7-14 days.
• For patients unable to swallow or use suspensions, clotrimazole troches (10 mg) dissolved slowly in the mouth five times daily for 7-14 days may be effective.

Important Considerations

• Treatment should continue for at least 48 hours after symptoms resolve.
• Patients should maintain good oral hygiene, including gentle brushing of the tongue and oral mucosa.
• If the patient uses dentures, these should be removed at night and disinfected daily.
• Oral thrush in hospitalized patients often results from immunosuppression, antibiotic use, or poor oral hygiene, so addressing these underlying factors is crucial for preventing recurrence.
• If symptoms don't improve within a week, alternative antifungal therapy or further investigation for underlying conditions may be necessary.

Key Points

• Fluconazole has been shown to be effective against most Candida species, with excellent penetration into the CSF and vitreous body 1.
• Itraconazole and voriconazole are alternative options, but their use is generally reserved for patients with mucosal candidiasis or those who have experienced treatment failure with fluconazole 1.
• Posaconazole and isavuconazole are also available, but their use is not as well-established for oral thrush treatment 1.

From the FDA Drug Label

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. The recommended dosage of SPORANOX ® Oral Solution for esophageal candidiasis is 100 mg (10 mL) daily for a minimum treatment of three weeks. Treatment should continue for 2 weeks following resolution of symptoms.

The recommended oral thrush medication as an inpatient is itraconazole (PO), with a dosage of 200 mg (20 mL) daily for 1 to 2 weeks for oropharyngeal candidiasis, and 100 mg (10 mL) daily for a minimum treatment of three weeks for esophageal candidiasis 2.

• Key points:
  • Swish the solution in the mouth for several seconds before swallowing
  • Take the medication without food, if possible
  • Treatment duration may vary depending on the patient's response to therapy 2.

From the Research

Oral Thrush Medication as an Inpatient

• The efficacy of single-dose fluconazole therapy for oral thrush in hospice and palliative medicine patients has been assessed in a study 3.
• The study found that 96.5% of patients had more than 50% improvement in signs and symptoms after treatment with 150 mg of fluconazole.
• Other antifungal drugs such as nystatin and miconazole are also effective in treating oral candidiasis, but may require a longer treatment duration 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 5.
• Topical amphotericin B has been reported to be effective in treating azole-refractory oropharyngeal candidiasis 6.
• A systematic review comparing oral and intra-vaginal anti-fungal treatments for uncomplicated vulvovaginal candidiasis found no statistically significant differences between the two routes of administration 7.

Treatment Options

• Fluconazole: a single dose of 150 mg can be effective in treating oral thrush 3.
• Nystatin: pastille or suspension can be used to treat oral candidiasis, with pastille being more effective in treating denture stomatitis 4, 5.
• Miconazole: can be used to treat oral candidiasis, but may interact with other drugs 4.
• Amphotericin B: can be used to treat azole-refractory oropharyngeal candidiasis 6.

Considerations

• The choice of antifungal medication and route of administration should be based on the individual patient's needs and medical history.
• The efficacy and safety of antifungal medications can vary depending on the specific formulation and dosage used.
• Further research is needed to determine the optimal treatment protocols and dosing regimens for antifungal medications in the treatment of oral thrush.