Fluconazole for Oral Thrush After Failed Nystatin in Immunocompetent Patient

Treatment Algorithm for Oral Thrush

The Infectious Diseases Society of America recommends fluconazole 100-200mg daily for 7-14 days for moderate to severe oral candidiasis in immunocompetent patients 1
For mild oral thrush, topical agents such as clotrimazole troches 10mg 5 times daily for 7-14 days are recommended 1
Nystatin suspension (100,000 U/mL) 4-6mL 4 times daily for 7-14 days is also a first-line treatment option for mild oral thrush 1

The IDSA guidelines support using fluconazole 150mg every 72 hours for 2-3 doses for severe cases of oral thrush 1
Fluconazole has potential drug interactions with some medications, although less than other azoles, as noted by the Journal of Microbiology, Immunology and Infection 2
For truly refractory cases that don't respond to fluconazole, itraconazole solution 200mg daily or posaconazole suspension 400mg twice daily for 3 days then 400mg daily may be considered 1