Fluconazole Resistant Candidiasis — ORE Part 1 MCQ

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ModeratePharmacology & TherapeuticsFluconazole Resistant CandidiasisORE Part 1

An adult taking long-term oral corticosteroids has extensive pseudomembranous oral candidiasis. They have completed an adequate course of topical nystatin with no clinical improvement. They are otherwise well, have no dysphagia or systemic features, and have no contraindication or important interacting medicine. What is the most appropriate next pharmacological treatment?

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Correct answer: B — Oral fluconazole 50 mg once daily for 7–14 days

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as D · D = shown as E

A is correct. This is extensive oral candidiasis that has not responded to an adequate topical nystatin course, without features suggesting oesophageal or invasive disease. SDCEP advises oral fluconazole for extensive or severe oral candidiasis; fluconazole is licensed for mucosal, including oropharyngeal, candidiasis. The important distinction is failure of topical nystatin, not proven fluconazole resistance. Intravenous amphotericin B is disproportionate for isolated oral disease in a well patient. Clotrimazole pessaries and ketoconazole cream are inappropriate intra-oral formulations. Repeating nystatin indefinitely neither addresses treatment failure nor the underlying corticosteroid-associated susceptibility. If systemic treatment also fails, Candida speciation/susceptibility testing and medical or specialist assessment are required.

Reference: Scottish Dental Clinical Effectiveness Programme, Management of Acute Dental Problems: Candidal infection (Oral thrush), 2026. https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/less-common-oral-conditions/candidal-infection-oral-thrush/