Oral Candidiasis

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Oral candidiasis (oral thrush) is an infection of the mouth by yeast. It mainly affects the very young, the very old or those whose immunity is  impaired. It occurs more frequently in HIV/AIDS patients, the malnourished, diabetics, patients on long-term antibiotics and corticosteroids and those with poor oral hygiene.

Cause

  • Candida albicans (monilia)

Symptoms

  • White patches in the mouth
  • Burning sensation in the mouth
  • Difficulty in swallowing
  • Breast fed babies may refuse to suck
  • Sore mouth

Signs

  • Well defined white or cream–coloured pustules and patches in the mouth  

Investigations

  • Buccal mucosal scraping for fungal elements
  • FBS 
  • Retroscreen

TreatmentTreatment Objectives

  • To eradicate infection
  • To identify and treat any underlying condition

Non-pharmacological treatment

  • Proper oral hygiene and toileting

Pharmacological treatment 

For treatment of uncomplicated oral candidiasis

1st Line Treatment

Evidence Rating: [B]

  • Nystatin suspension, oral,

Adults

100,000 units 6 hourly after food for 14 days

Children

100,000 units 6 hourly after each feed for at least 10 days. Make sure it is spread well in the mouth.

2nd Line Treatment

  • Miconazole, oral gel, 

Adults and Children

2.5ml smeared on the oral mucosa twice daily for 7-10 days

For immunocompromised patients with oral candidiasis

Evidence Rating: [B]

  • Fluconazole, oral,

Adults

50-100 mg daily for 7-14 days

Children

12-18 years 50-100 mg daily for 7-14 days

14 days-12 years; 3-6 mg/kg on first day, Then 3 mg/kg (max. 100 mg) daily for 14 days

7-14 days; 3-6 mg/kg on first day Then 3 mg/kg every 48 hours for 14 days

< 7 days; 3-6 mg/kg on first day Then 3 mg/kg every 72 hours for 14 days

Referral Criteria

Refer patients not responding to above treatment or if there is the presence of an underlying illness e.g. diabetes mellitus, immunosuppression to appropriate specialist.