Oral Antifungal Treatment — MFDS Part 1 MCQ

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ModeratePharmacologyOral Antifungal TreatmentMFDS Part 1

A 68-year-old patient has mild, localised erythematous candidiasis beneath a removable complete upper denture. The patient is otherwise well, has no liver disease and takes no medicines that interact with azole antifungals. Alongside denture removal and disinfection, which antifungal is the most appropriate first-line treatment?

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Correct answer: C — Miconazole oral gel

Miconazole oral gel is the best answer for mild, localised denture-associated candidiasis when there are no contraindications or important interactions. It provides topical treatment of the affected mucosa, and its SmPC specifically instructs that dental prostheses should be removed at night and brushed with the gel. Denture removal and disinfection remain essential because medication alone will not eliminate the predisposing reservoir. Fluconazole is systemic treatment and is generally considered for extensive, severe or topical-treatment-resistant infection. Nystatin suspension is a reasonable alternative when miconazole is unsuitable, but is not preferred in this uncomplicated scenario. Intravenous amphotericin B is reserved for serious systemic fungal infection, while griseofulvin treats dermatophyte infections and is ineffective against Candida. Miconazole should be avoided in patients taking warfarin or acenocoumarol because of potentially severe enhancement of anticoagulation.

Reference: Daktarin Oral Gel, Summary of Product Characteristics, sections 4.1–4.5, updated 11 May 2026. https://www.medicines.org.uk/emc/product/14746/smpc