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ICS-related oral candidiasis — GPhC CRA MCQ

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EasyAdverse Drug ReactionsICS-related oral candidiasisGPhC CRA

A 72-year-old man using beclometasone 200 micrograms twice daily for COPD presents with white patches on his tongue and soreness in his mouth. He denies difficulty swallowing. What is the most likely cause and the most appropriate initial management?

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Correct answer: B — Oral candidiasis related to inhaled corticosteroid use — recommend miconazole oral gel

White patches on the tongue with oral soreness in a patient using inhaled corticosteroids is characteristic of oral candidiasis (thrush), a well-known side effect of ICS use. Miconazole oral gel is appropriate first-line OTC treatment. The patient should also be counselled to rinse their mouth with water after each ICS dose and to consider using a spacer to reduce oropharyngeal deposition. Urgent referral is not warranted in the absence of red-flag features.

Reference: BNF; NICE CKS Oral Candidiasis