From the Guidelines
Thrush can be effectively treated with oral fluconazole, which is considered the drug of choice due to its effectiveness and convenience. For oral thrush, the recommended treatment options include:
- Clotrimazole troches at a dosage of 10 mg 5 times daily for 7-14 days 1
- Nystatin suspension at a concentration of 100,000 U/mL and a dosage of 4–6 mL 4 times daily for 7-14 days 1
- Oral fluconazole at a dosage of 100–200 mg daily for 7–14 days, which is considered the most effective and convenient option 1 It is essential to note that the treatment approach may vary depending on the severity of the disease, with fluconazole being recommended for moderate to severe cases 1. Additionally, for fluconazole-refractory disease, alternative options such as itraconazole solution or posaconazole suspension may be considered 1. Maintaining good hygiene, avoiding irritants, and completing the full course of medication are crucial for effective treatment and preventing recurrence.
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 recommended for the treatment of oropharyngeal candidiasis, which includes thrush, at a dosage of 200 mg (20 mL) daily for 1 to 2 weeks 3.
From the Research
Treatment Options for Thrush
- Topical antifungal agents such as nystatin, miconazole, and clotrimazole are commonly used to treat thrush 4, 5
- Systemic antifungal agents like fluconazole, itraconazole, and voriconazole may be used in cases where topical treatment is not effective or in severe cases of thrush 4, 6
- Newer antifungal agents such as echinocandins (anidulafungin, caspofungin) and isavuconazole may also be used to treat thrush 4
- Combination therapy using both systemic and topical antifungal agents may be effective in treating recurrent candidiasis 7
Considerations for Treatment
- The choice of antifungal agent may depend on the severity of the infection, the patient's medical history, and the presence of any underlying conditions 4, 6
- Topical antifungal agents may interact with other medications, and patients should be advised to consult their doctor before using them 4
- Systemic antifungal agents may have side effects, and patients should be monitored closely while taking them 6
- Eradication of predisposing factors is essential in the treatment of thrush 5
Efficacy of Treatment Options
- Nystatin, miconazole, and fluconazole have been shown to be effective in treating oral candidiasis 4
- Itraconazole and clotrimazole have been shown to be more effective than fluconazole in treating acute vaginal candidiasis 8
- Combination therapy using fluconazole and metronidazole + clotrimazole may be effective in treating recurrent vulvovaginal candidiasis 7