Fluconazole Oral Candidiasis — MFDS Part 1 MCQ

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ModeratePharmacologyFluconazole Oral CandidiasisMFDS Part 1

An adult has extensive pseudomembranous oral candidiasis. Predisposing local factors have been addressed, but an adequate course of topical antifungal treatment has failed. There is no dysphagia, systemic illness or evidence of invasive infection. Which systemic antifungal is most appropriate in primary dental care?

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Correct answer: C — Oral fluconazole

The correct answer is C: oral fluconazole. SDCEP recommends systemic fluconazole for oral candidal infection, and it is the appropriate systemic step when adequate topical treatment (e.g. miconazole gel or nystatin) has failed in extensive disease. The absence of dysphagia, systemic illness or invasive infection supports management as oropharyngeal candidiasis rather than oesophageal or disseminated disease. Griseofulvin and terbinafine are used principally for dermatophyte infections and have no routine role against oral Candida. Intravenous amphotericin B and caspofungin are reserved for invasive, refractory or otherwise serious fungal infections managed in hospital, not for oropharyngeal candidiasis in primary dental care. Before prescribing fluconazole, check contraindications, pregnancy status and clinically important interactions, notably potentiation of warfarin via CYP2C9 inhibition.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP), Management of Acute Dental Problems — Conditions library: Candidal infection (Oral thrush), current web guidance. https://madp.sdcep.org.uk/content/conditions-library/candidal_infection.html