From the Guidelines
Thrush is best treated with oral fluconazole, which is as effective as and sometimes superior to topical therapy, and is more convenient and generally better tolerated. According to the CDC, NIH, and HIV Medicine Association/Infectious Diseases Society of America recommendations 1, oral fluconazole is the preferred treatment for oropharyngeal candidiasis. The treatment options for thrush include:
- Oral fluconazole, which is as effective as and sometimes superior to topical therapy, and is more convenient and generally better tolerated 1
- Topical therapy, including clotrimazole troches or nystatin suspension or pastilles, which can be used to treat initial episodes of oropharyngeal candidiasis, but may not be as effective as oral fluconazole 1
- Itraconazole oral solution, which is as effective as oral fluconazole but less well tolerated 1
- Ketoconazole and itraconazole capsules, which are less effective than fluconazole due to their more variable absorption and should be considered second-line alternatives 1
It is essential to maintain good oral hygiene while using these medications, including brushing teeth and tongue gently twice daily and rinsing with warm saltwater. For denture wearers, removing and cleaning dentures nightly and soaking them in an antifungal solution can help prevent thrush. If symptoms persist or worsen, it is crucial to see a healthcare provider, as this may indicate an underlying condition requiring additional treatment.
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.
Thrush Treatment:
- Nystatin Oral Suspension, USP, is indicated for the treatment of candidiasis in the oral cavity, which includes thrush 2.
- Itraconazole Oral Solution is also effective for the treatment of oropharyngeal candidiasis, which includes thrush, with a recommended dosage of 200 mg (20 mL) daily for 1 to 2 weeks 3.
From the Research
Definition and Causes of Thrush
- Thrush, also known as candidiasis, is a fungal infection caused by the Candida fungus, which is present in the mouths of up to 60% of healthy people 4, 5.
- Overt infection is associated with immunosuppression, diabetes, broad-spectrum antibiotics, and corticosteroid use 4, 5.
Treatment and Prevention of Thrush
- Antifungal treatments, such as fluconazole, clotrimazole, and nystatin, can be used to treat thrush 4, 6, 5, 7, 8.
- Topical antifungal agents, such as fluconazole and amphotericin B, are recommended for adults with oral candidiasis 8.
- For immunosuppressed patients, clotrimazole and itraconazole have similar clinical response and mycological cure rates, but itraconazole has a lower relapse rate 8.
- In infants, miconazole and nystatin have similar clinical response rates, but miconazole has a superior mycological cure rate 8.
Comparison of Treatment Options
- Oral and intra-vaginal anti-fungal treatments have similar effectiveness for uncomplicated vulvovaginal candidiasis (thrush) 6.
- Fluconazole is more effective than nystatin in preventing Candida infections in patients with leukemia 7.
- Fluconazole has a better clinical response rate than clotrimazole for adults with oral candidiasis, but a similar mycological cure rate 8.