Topical antifungal therapy for oral and oropharyngeal candidiasis in adults
The topical antifungals recommended in this topic have similar efficacy; drug choice is influenced by practical considerations:
- amphotericin B lozenges may not be suitable for adults who have dry mouth or difficulty sucking or swallowing
- miconazole may be systemically absorbed, so drug interactions are possible (whereas topical nystatin or amphotericin B have negligible systemic absorption)Pemberton, 2018Hellfritzsch, 2017Martin-Perez, 2018
- certain brands of nystatin liquid are not preferred because of high concentrations of sucrose, which can promote accumulation of plaque on the teeth and dental caries (tooth decay).
For adults with oral or oropharyngeal candidiasis, useNorthern Devon Healthcare, 2017Pappas, 2016Zhang, 2016:
1miconazole 2% gel 2.5 mL topically (then swallowed), 4 times daily after food and drink, for 7 to 14 days as guided by symptom resolution. Place directly in the mouth and on the tongue miconazole miconazole miconazole
OR
1nystatin 100 000 units/mL liquid 1 mL topically (then swallowed), 4 times daily after food and drink, for 7 to 14 days as guided by symptom resolution1. Place under tongue or in buccal cavity nystatin nystatin nystatin
OR
2amphotericin B 10 mg lozenge sucked (then swallowed), 4 times daily after food and drink, for 7 to 14 days as guided by symptom resolution. amphotericin b lozenge amphotericin B lozenge amphotericin B lozenge
Successful treatment relies on adequate contact time between the antifungal and the affected mucosa – advise adults not to eat or drink directly after administration.
For adults with severe oropharyngeal candidiasis (eg multiple or confluent lesions, swallowing difficulties) or who do not respond to topical treatment, medical practitioners can consider oral antifungal therapy.