Treatment of Oral Thrush

Introduction to Treatment

The Infectious Diseases Society of America recommends clotrimazole troches 10 mg 5 times daily or miconazole mucoadhesive buccal 50-mg tablet applied once daily for 7-14 days for mild oral thrush (strong recommendation; high-quality evidence) 1, 2
The Infectious Diseases Society of America recommends oral fluconazole 100-200 mg daily for 7-14 days for moderate to severe oral thrush (strong recommendation; high-quality evidence) 1, 2

For mild oral thrush, alternative options include nystatin suspension (100,000 U/mL) 4-6 mL 4 times daily or 1-2 nystatin pastilles (200,000 U each) 4 times daily for 7-14 days (strong recommendation; moderate-quality evidence) 1, 2
For fluconazole-refractory disease, itraconazole solution 200 mg once daily for up to 28 days is recommended (strong recommendation; moderate-quality evidence) 1
For fluconazole-refractory disease, posaconazole suspension 400 mg twice daily for 3 days then 400 mg daily for up to 28 days is recommended (strong recommendation; moderate-quality evidence) 1
For fluconazole-refractory disease, voriconazole 200 mg twice daily is recommended (strong recommendation; moderate-quality evidence) 1
For fluconazole-refractory disease, amphotericin B deoxycholate oral suspension 100 mg/mL 4 times daily is recommended (strong recommendation; moderate-quality evidence) 1

For denture-related candidiasis, disinfection of the denture is essential in addition to antifungal therapy (strong recommendation; moderate-quality evidence) 1, 3
For HIV-infected patients, antiretroviral therapy is strongly recommended to reduce recurrent infections (strong recommendation; high-quality evidence) 1, 2
For recurrent infections in HIV patients, suppressive therapy with fluconazole 100 mg three times weekly may be necessary (strong recommendation; high-quality evidence) 1, 3

Clinical response to topical therapy should be seen within 48-72 hours 4
For moderate to severe cases treated with fluconazole, improvement typically occurs within 5-7 days 3
Chronic suppressive therapy is usually unnecessary unless the patient has frequent recurrences 1, 2

Oral cultures are generally not needed for diagnosis or management of uncomplicated cases 4, 5