Oral and oropharyngeal candidiasis in palliative care

Oral and oropharyngeal candidiasis occurs in many patients with palliative care needs; symptoms include characteristic white plaques on the oral mucosa, and dry mouth with abnormal taste.

For information on management of oropharyngeal candidiasis in patients with human immunodeficiency virus (HIV) infection, see the Antibiotic guidelines.

Choice of initial antifungal therapy for oral and oropharyngeal candidiasis depends on disease severity. Use topical therapy unless the patient has severe disease (eg multiple or confluent lesions, swallowing difficulties caused by candidiasis).

For initial therapy of nonsevere oral or oropharyngeal candidiasis for patients with palliative care needs, use:

Successful treatment relies on adequate contact time between the antifungal and the affected mucosa, so advise patients not to eat or drink directly after administrationWiseman, 2006.

For patients with dentures, miconazole is preferred over nystatin because of better retention on the denture surface. See the Oral and Dental guidelines for more information and guidance on denture hygiene.

Amphotericin B lozenges are not recommended because patients with palliative care needs often have a dry mouth, so are unable to effectively suck the lozenge.

For initial therapy of severe oral or oropharyngeal candidiasis in patients with palliative care needs, or treatment of nonsevere candidiasis that does not respond to topical therapy, use:

If symptoms do not improve on oral therapy, depending on the patient's prognosis, goals of care and preferences, consider: