From the Guidelines
The best treatment for thrush (oral candidiasis) is antifungal medication, with fluconazole being the most effective option for most adults, as recommended by the most recent guidelines 1. For mild cases, topical treatments like nystatin oral suspension (swish and swallow 4-5 times daily for 7-14 days) or clotrimazole troches (dissolved in the mouth 5 times daily for 7-14 days) are typically sufficient.
- Key considerations for treatment include:
- Severity of symptoms
- Presence of underlying conditions, such as HIV infection or diabetes
- History of previous treatments and responses
- For more severe or persistent cases, oral fluconazole (200mg on day 1, followed by 100mg daily for 7-14 days) is recommended, as it has been shown to be effective in treating oropharyngeal candidiasis 1.
- For infants, nystatin oral suspension applied to affected areas with a cotton swab 4 times daily is the standard treatment. It's essential to continue treatment for at least 48 hours after symptoms resolve to prevent recurrence. Good oral hygiene is crucial during treatment, including regular brushing, denture cleaning (if applicable), and avoiding sugary foods that promote fungal growth. Thrush occurs when the Candida fungus, normally present in the mouth, overgrows due to factors like antibiotic use, weakened immune system, diabetes, or poor oral hygiene. If symptoms persist after treatment or recur frequently, medical evaluation is necessary to identify underlying causes, as recommended by the guidelines 1. In cases of fluconazole-refractory disease, itraconazole solution or posaconazole suspension may be effective alternatives, as suggested by the evidence 1.
From the FDA Drug Label
The recommended dosage of SPORANOX ® (itraconazole) Oral Solution for oropharyngeal candidiasis is 200 mg (20 mL) daily for 1 to 2 weeks. The best treatment for thrush (oropharyngeal candidiasis) is Itraconazole Oral Solution at a dose of 200 mg (20 mL) daily for 1 to 2 weeks 2.
From the Research
Treatment Options for Thrush
- The most commonly used topical antifungal drugs for treating thrush are nystatin and miconazole, which are very effective but require a long treatment duration 3.
- Other topical alternatives, such as amphotericin B or clotrimazole, may not be available in many countries 3.
- Oral fluconazole is effective in treating thrush that does not respond to topical treatment, and it has been shown to be effective in a single-dose regimen for hospice and palliative medicine patients 3, 4.
- Systemic treatment alternatives, such as itraconazole, voriconazole, or posaconazole, are less commonly used but can be effective for recalcitrant infections 3.
Efficacy of Antifungal Drugs
- A Bayesian network meta-analysis found that itraconazole, miconazole, fluconazole, and ketoconazole were more effective than nystatin in reducing the mycological cure rate in oral candidiasis 5.
- The same study found that fluconazole had a better effect than other drugs in reducing the risk of the mycological cure rate in oral candidiasis 5.
- A systematic review found that antifungal drugs, including fluconazole, itraconazole, and clotrimazole, were effective in treating oropharyngeal candidiasis, but the quality of evidence varied 6.
Comparison of Treatment Regimens
- A study comparing single-dose oral fluconazole with 3-day intravaginal clotrimazole found that fluconazole was more effective in the long term and relieved symptoms more rapidly 7.
- Another study found that single-dose fluconazole was effective in treating oral thrush in hospice and palliative medicine patients, with 96.5% of patients showing more than 50% improvement in signs and symptoms 4.