Treatment of Adult Thrush
Recommended Treatment
- The Infectious Diseases Society of America recommends oral fluconazole 100-200 mg daily for 7-14 days for moderate to severe oropharyngeal candidiasis in adults (strong recommendation; high-quality evidence) 1
- For mild oropharyngeal candidiasis, topical therapy is preferred, with options including clotrimazole troches 10 mg five times daily for 7-14 days (strong recommendation; high-quality evidence) 1
- Alternative topical treatments include miconazole mucoadhesive buccal 50-mg tablet applied to the mucosal surface over the canine fossa once daily for 7-14 days 1
- 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 can also be used 1
Fluconazole-Refractory Disease
- For fluconazole-refractory disease, alternative agents include itraconazole solution 200 mg once daily for up to 28 days (strong recommendation; moderate-quality evidence) 1
- Posaconazole suspension 400 mg twice daily for 3 days, then 400 mg daily for up to 28 days can also be used 1
- Voriconazole 200 mg twice daily is another option 1
- Amphotericin B deoxycholate oral suspension 100 mg/mL four times daily can be used for severe cases 1
- Intravenous echinocandin (caspofungin 70-mg loading dose, then 50 mg daily; micafungin 100 mg daily; or anidulafungin 200-mg loading dose, then 100 mg daily) can be used for severe refractory cases 1
Special Populations
- For HIV-infected patients, antiretroviral therapy is strongly recommended to reduce the incidence of recurrent infections (strong recommendation; high-quality evidence) 1
- Chronic suppressive therapy with fluconazole 100 mg three times weekly can be used for recurrent infection 1
- For denture-related candidiasis, disinfection of the denture in addition to antifungal therapy is required (strong recommendation; moderate-quality evidence) 1