What are the recommendations for managing oral candidiasis?

From the Guidelines

Oral candidiasis management recommendations are straightforward: for mild disease, topical antifungals such as clotrimazole or nystatin are recommended, while for moderate to severe disease, oral fluconazole is the preferred treatment.

Treatment Options

• For mild oral candidiasis, treatment with clotrimazole troches at a dosage of 10 mg 5 times daily, nystatin suspension at a concentration of 100,000 U/mL and a dosage of 4–6 mL 4 times daily, or 1–2 nystatin pastilles (200,000 U each) administered 4 times daily for 7–14 days is recommended 1.
• For moderate to severe oral candidiasis, oral fluconazole at a dosage of 100–200 mg (3 mg/kg) daily for 7–14 days is recommended 1.
• For fluconazole-refractory disease, either itraconazole solution at a dosage of 200 mg daily or posaconazole suspension at a dosage of 400 mg twice daily for 3 days, then 400 mg daily for up to 28 days, are recommended 1.

Special Considerations

• Chronic suppressive therapy is usually unnecessary for patients with HIV infection, but if required, fluconazole at a dosage of 100 mg 3 times weekly is recommended 1.
• For denture-related candidiasis, disinfection of the denture, in addition to antifungal therapy, is recommended 1.
• Daily bathing of ICU patients with chlorhexidine could be considered to decrease the incidence of bloodstream infections including candidemia 1.

From the Research

Management of Oral Candidiasis

The management of oral candidiasis involves a combination of good oral hygiene, topical agents, and systemic medications 2. The goal of treatment is to eliminate the underlying cause of the infection and reduce symptoms.

Treatment Options

• Topical agents, such as antifungal medications, can be effective in treating oral candidiasis 2, 3
• Systemic medications may be necessary in severe cases or when the infection is caused by an underlying systemic condition 3, 4
• Good oral hygiene practices, such as regular brushing and flossing, can help prevent the recurrence of oral candidiasis 2, 5

Importance of Underlying Condition Management

• It is essential to identify and manage any underlying host predisposing factors, such as diabetes mellitus or human immunodeficiency virus infection, to effectively treat oral candidiasis 6, 3, 4, 5
• Failure to address underlying conditions can lead to recurrent or persistent infections 6, 4

Antifungal Therapy

• Antifungal therapy may be necessary as part of initial management, especially in cases where the infection is caused by Candida species other than C. albicans 4, 5
• The choice of antifungal agent will depend on the severity of the infection and the presence of any underlying conditions 4, 5