Treatment of Oral Candidiasis in Elderly Patients

Introduction to Treatment Options

• The Infectious Diseases Society of America recommends clotrimazole troches 10 mg five times daily or miconazole mucoadhesive buccal 50-mg tablet once daily for 7-14 days for mild oral candidiasis in elderly patients 1
• For moderate to severe disease, the Infectious Diseases Society of America recommends oral fluconazole 100-200 mg daily for 7-14 days, supported by high-quality evidence 1, 3

Treatment Algorithm by Disease Severity

• The American College of Physicians and the Infectious Diseases Society of America suggest that alternative topical agents include nystatin suspension (100,000 U/mL) 4-6 mL four times daily, or 1-2 nystatin pastilles (200,000 U each) four times daily for 7-14 days 1, 3
• The Infectious Diseases Society of America recommends itraconazole oral solution 200 mg once daily for up to 28 days as the first-line alternative for fluconazole-refractory disease 1, 2

Special Considerations in Elderly Patients

• The Infectious Diseases Society of America and the American Dental Association recommend disinfection of dentures as mandatory in addition to antifungal therapy to prevent reinfection in denture-related candidiasis 1, 4, 2
• The Infectious Diseases Society of America recommends chronic suppressive therapy with fluconazole 100 mg three times weekly for patients with recurrent infections 1, 2

Common Pitfalls to Avoid

• The American College of Physicians and the Infectious Diseases Society of America advise against discontinuing therapy prematurely once symptoms resolve, and recommend completing the full 7-14 day course to prevent recurrence 2
• The Infectious Diseases Society of America warns against using fluconazole capsules and oral solution interchangeably, as only the oral solution has demonstrated effectiveness for oral candidiasis, and against relying on fluconazole in patients who received azole prophylaxis, as resistance is likely 5
• The American Dental Association and the Infectious Diseases Society of America emphasize the importance of addressing denture hygiene to prevent treatment failure and rapid relapse 1, 4, 2