From the Guidelines
Terbinafine is not indicated for recurrent oral candidiasis. The most recent and highest quality study, 1, recommends systemic antifungal therapy with fluconazole as the first-line treatment for oral candidiasis. According to this study, oral fluconazole, 200–400 mg (3–6 mg/kg) daily, for 14–21 days is recommended for the treatment of oral candidiasis.
Key Points to Consider
- Terbinafine is primarily effective against dermatophytes and has poor activity against Candida species.
- The treatment of recurrent oral candidiasis should focus on identifying and addressing underlying causes, such as immunosuppression, diabetes, or ill-fitting dentures.
- In cases of frequent recurrence, longer courses of fluconazole or maintenance therapy might be necessary.
Recommended Treatment
- Fluconazole (100-200mg daily for 7-14 days) is the recommended first-line treatment for oral candidiasis, as stated in 1.
- Other options, such as nystatin (oral suspension 400,000-600,000 units four times daily) or clotrimazole troches (10mg dissolved in mouth five times daily), may also be considered.
Important Considerations
- Chronic suppressive therapy with fluconazole, 100–200 mg 3 times weekly, is recommended for patients with recurrent esophagitis, as stated in 1.
- Antiretroviral therapy is strongly recommended for HIV-infected patients to reduce the incidence of recurrent infections, as stated in 1.
From the FDA Drug Label
Terbinafine has been shown to be active against most strains of the following microorganisms both in vitro and in clinical infections: ... The following in vitro data are available, but their clinical significance is unknown In vitro, terbinafine exhibits satisfactory MIC’s against most strains of the following microorganisms; however, the safety and efficacy of terbinafine in treating clinical infections due to these microorganisms have not been established in adequate and well-controlled clinical trials: Candida albicans The FDA drug label does not indicate that terbinafine is approved for the treatment of recurrent oral candidiasis. Although it exhibits activity against Candida albicans in vitro, the safety and efficacy of terbinafine in treating clinical infections due to this microorganism have not been established in adequate and well-controlled clinical trials 2.
From the Research
Terbinafine in Recurrent Oral Candidiasis
- The effectiveness of terbinafine in treating recurrent oral candidiasis is not well-established in the provided studies 3, 4, 5, 6, 7.
- Terbinafine has fungistatic activity against Candida albicans, but its use is primarily indicated for dermatophyte infections such as onychomycosis, tinea pedis, and tinea corporis/cruris 3.
- For oral candidiasis, other antifungal agents like fluconazole, itraconazole, and nystatin are commonly used and have shown efficacy in treatment 4, 5, 6.
- One study compared terbinafine with itraconazole and fluconazole in the treatment of Vulvovaginal candidiasis, but the results do not directly apply to oral candidiasis 7.
- There is limited evidence to support the use of terbinafine as a first-line treatment for recurrent oral candidiasis, and more research is needed to determine its effectiveness in this context 3, 4, 5, 6, 7.