Oral candidiasis
Guidelines
The following summarized guidelines for the management of oral candidiasis (OC) are prepared by our editorial team based on guidelines from the Infectious Diseases Society of America (IDSA/CDC/NIH/HIVMA 2023), the Infectious Diseases Society of America (IDSA 2016), and the European Society for Microbiology and Infectious Diseases (ESCMID 2012).
1. Medical management
Antifungal therapy
- Offer any of the following in patients with mild OC:clotrimazole troches 10 mg 5 times daily for 7-14 daysmiconazole mucoadhesive buccal 50 mg tablet applied to the mucosal surface over the canine fossa once daily for 7-14 days.
2. Specific circumstances
Pragnant patients
do not use voriconazole, anidulafungin and caspofungin in pregnant patients.
Patients with denture-related candidiasis
offer disinfection of the denture in addition to antifungal therapy in patients with denture-related candidiasis.
Patients with HIV, prevention
- As per IDSA/HIVMA/CDC/NIH 2023 guidelines, do not offer routine primary prophylaxis for OC because mucosal disease is associated with very low attributable morbidity and mortality, acute therapy for treatment is highly effective, antifungal prophylaxis can lead to infections caused by drug-resistant Candida strains and introduce significant drug-drug interactions, and moreover, long-term oral prophylaxis is expensive.
- As per IDSA 2016 guidelines, ensure proper antiretroviral therapy to reduce the incidence of recurrent infections in human immunodeficiency virus-infected patients.
- As per ESCMID 2012 guidelines, do not offer primary antifungal prophylaxis for the prevention of oropharyngeal candidiasis.
Patients with HIV, antifungal therapy
- As per IDSA/HIVMA/CDC/NIH 2023 guidelines, offer oral fluconazole at 100 mg once daily for 1- 2 weeks as the drug of choice for the treatment of patients with oropharyngeal candidiasis except during pregnancy.
- As per ESCMID 2012 guidelines, offer fluconazole 100 mg daily for 7-14 days as first-line therapy in adult and pediatric patients with oropharyngeal candidiasis.
Patients with HIV, management of treatment failure
- As per IDSA/HIVMA/CDC/NIH 2023 guidelines, offer posaconazole immediate-release oral suspension 400 mg BID for 28 days in patients with azole-refractory oropharyngeal candidiasis.
- As per ESCMID 2012 guidelines, avoid using any topical antifungal agent, such as amphotericin B.
3. Preventative measures
Chronic suppressive therapy
- Avoid offering chronic suppressive therapy in patients with OC.
- Offer fluconazole 100 mg 3 times weekly if chronic suppressive therapy is required in patients with recurrent infection.