Oral Candidiasis
Antimicrobial prescribing: NHS Forth Valley
Swabs to detect Candida albicans are not thought to be diagnostically helpful as candidal organisms are a normal commensal found in many healthy people.
Oral carriage of Candida is reported to be:
-
- 45–65% in healthy children.
- 45% in neonates.
- 30–45% in healthy adults.
Consider the range of differential diagnoses of oral candidiasis
Unusual presentation in immunocompetent adults; consider risk factors including HIV testing (unexplained oral candidiasis is an HIV indicator condition)
Give appropriate lifestyle advice to aid healing and prevent recurrence alongside antifungal therapy.
Ensure good oral hygiene is maintained including denture cleansing. Consider use of chlorhexidine mouthwash including denture soaking (do not use in combination with nystatin)
Review patients' medicines and ensure patients are using correctly (e.g. inhalers) and not overusing (e.g. steroid nasal sprays).
Review blood glucose control if diabetic.
Drug details
Miconazole oral gel
(Supplies are often unreliable)
2.5ml of 24mg/ml QDS (applied after meals)
Continued for at least 7 days after lesions have healed or symptoms have cleared.
Should not be swallowed immediately but kept in the mouth as long as possible.
Any dental prostheses / orthodontic appliances should be removed at night and brushed with gel.
If miconazole gel not suitable or not available:
Nystatin suspension
1ml of 100,000units/mL QDS (after food or drink)
7 days or until 2 days after symptoms resolve
Should be kept in contact with affected areas for as long as possible
If the infection is extensive or severe infection:
Fluconazole
(Avoid in pregnancy)
200mg on Day 1 followed by 100mg once daily
7-21 days (guided by severity of symptoms and clinical response on therapy)