What is the role of medications in the treatment of thrush?

Updated: Jan 17, 2019
  • Author: Mudra Kumar, MD, MRCP, FAAP; Chief Editor: Russell W Steele, MD  more...
  • Print
Answer

Antifungal therapy generally hastens resolution of infection. [11, 39] The treatment of choice for thrush is fluconazole or oral nystatin suspension, although numerous antifungal agents are effective. Resistance to nystatin is rare, although the drug's contact killing makes it somewhat more difficult to use because it must be applied to all of the affected mucosal surfaces to be effective (unlike systemic therapies). Failures with nystatin are more common than with fluconazole. [12]

In older children and adults, antifungal medications should be swished around in the oral cavity and swallowed. Failure to do so may provide ineffective treatment for lesions in the posterior pharynx and esophagus. In younger patients, instruct parents to apply 1-2 mL of the solution to the inside of each cheek during each administration. Medication can also be directly applied to the lesions with a nonabsorbent swab or applicator. The best time to administer medication is between meals because this allows longer contact time.

Gentian violet solution should not be swallowed. Lozenges (troches) may be used if suspension preparations are unavailable.

These antifungal preparations have minimal adverse effects and few contraindications because they involve little or no systemic absorption. Aside from itraconazole, against which candidal resistance is increasing, other readily available antifungals are effective. If inability to adequately apply nystatin (or the oral cavity's normal flushing mechanisms) results in treatment failure, oral fluconazole or gentian violet are second-line agents.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!