Oral candidiasis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Oral candidiasis can be treated with topical anti-fungal drugs, such as nystatin (mycostatin), miconazole or amphotericin B. Patients who are immunocompromised, either with HIV/AIDS or as a result of chemotherapy, may require systemic treatment with oral or intravenous administered anti-fungals.

Medical Therapy

Any underlying cause, such as poor glucose control in diabetics, should be addressed. Oral candidiasis can be treated with topical anti-fungal drugs, such as nystatin (mycostatin), miconazole or amphotericin B. Patients who are immunocompromised, either with HIV/AIDS or as a result of chemotherapy, may require systemic treatment with oral or intravenous administered anti-fungals.

For adults, mild cases can be first treated by drinking acidic substances, such as orange juice, to make a harsher environment for the yeast and eating yogurt to replenish bacterial count that controls the yeast. If home treatment is not effective a physician may need to be consulted.

Candida infections of the mouth and throat must be treated with prescription antifungal medication. The type and duration of treatment depends on the severity of the infection and patient-specific factors such as age and immune status. Untreated infections can lead to a more serious form of invasive candidiasis.

Oral candidiasis usually responds to topical treatments such as clotrimazole troches and nystatin suspension (nystatin - swish and swallow). Systemic antifungal medication such as fluconazole or itraconazole may be necessary for oropharyngeal infections that do not respond to these treatments.

Candida esophagitis is typically treated with oral or intravenous fluconazole or oral itraconazole. For severe or azole-resistant esophageal candidiasis, treatment with amphotericin B may be necessary.

Treatment Regimen

• Oropharyngeal candidiasis

• Preferred regimen: Clotrimazole troches 10 mg TOP q4-5h OR Nystatin suspension or pastilles TOP q6h OR Fluconazole 100–200 mg PO q24h
• Alternative regimen: Itraconazole solution 200 mg PO q24h OR Posaconazole 400 mg PO q24h OR Voriconazole 200 mg PO q24h OR Amphotericin B oral suspension PO q24h OR (Anidulafungin 200 mg IV once THEN Anidulafungin 100 mg IV q24h) OR (Caspofungin 70 mg IV once THEN Caspofungin 50 mg IV q24h) OR Micafungin 100 mg IV q24h OR Amphotericin B 0.3 mg/kg IV q24h
• Note: Treat uncomplicated disease for 7–14 days. Fluconazole is recommended in moderate-to-severe disease, and topical therapy with Clotrimazole or Nystatin is recommended for mild disease. For refractory disease, consider the alternative regimen.

• Medical treatment of oropharyngeal candidiais in immunocompromised patients:

Most patients respond initially to topical therapy using the same regimen above but relapses occur rapidly if fluconazole fluconazole (400 mg [6 mg/kg} daily)is not used.

• In pediatric patients: use itraconazole in a dose of 2.5 mg/kg/day.
• Continuous prophylactic fluconazole use is more effective than intermittent use in relapses.
• In fluconazole resistent cases: Itraconazole (200 mg twice daily) can be used with cure rate between 64 - 80%
• Posaconazole (200 mg 3 times daily) can be used with cure rate of 80%
• Intravenous caspofungin (200 mg 3 times daily), micafungin (50 mg daily), or anidulafungin (loading dose of 200 mg and 100 mg daily) can be used as alternatives to triazoles.

Videos

• Treatment

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• Treatment in Newborn:

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