Oral Fluconazole Dosing for Severe Thrush
For severe oropharyngeal thrush (oral thrush), oral fluconazole 100-200 mg daily for 7-14 days is the recommended treatment. 1
Dosing Algorithm for Severe Disease
The standard regimen is fluconazole 100-200 mg once daily for 7-14 days, with the higher dose (200 mg) preferred for more severe presentations. 1
Key Dosing Points:
Moderate to severe thrush requires systemic therapy rather than topical agents like clotrimazole troches or nystatin, which are reserved for mild disease 1
The 200 mg daily dose is specifically recommended when disease severity is pronounced, as this provides more reliable therapeutic drug levels 1
Treatment duration should be a minimum of 7 days, with 14 days preferred to reduce recurrence risk, even if symptoms resolve earlier 2
For esophageal involvement (which often accompanies severe oral thrush), increase the dose to 200-400 mg daily for 14-21 days 1
Special Considerations
Immunocompromised Patients:
HIV-infected patients and other immunocompromised individuals should receive the full 14-day course at 100-200 mg daily 1
Chronic suppressive therapy with fluconazole 100 mg three times weekly may be necessary for recurrent infections in patients with ongoing immunosuppression 1, 2
Refractory Disease:
If the patient fails to respond to fluconazole after 7-10 days:
- Switch to itraconazole solution 200 mg once daily 1
- Alternative: posaconazole suspension 400 mg twice daily for 3 days, then 400 mg daily for up to 28 days 1
- Alternative: voriconazole 200 mg twice daily 1
Common Pitfalls
Resistance may develop during therapy, particularly with Candida glabrata; monitor clinical response closely 2
For denture-related candidiasis, disinfection of the denture is essential in addition to antifungal therapy, as failure to address this will result in treatment failure 1, 2
Avoid premature discontinuation—completing the full 7-14 day course is critical even when symptoms improve within 2-3 days, as early cessation leads to high relapse rates 2
Single-dose fluconazole 150 mg (used for vaginal candidiasis) is inadequate for oral thrush and should not be used, despite some limited data suggesting benefit in palliative care settings 3