Oral thrush nystatin counselling — GPhC CRA MCQ
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Correct answer: A — Maximise oral nystatin contact and correct corticosteroid inhaler technique
Maximise oral nystatin contact and correct corticosteroid inhaler technique: Effective local exposure treats the current candidiasis, while technique review and rinsing reduce future oropharyngeal steroid deposition. Swallow nystatin immediately and pause inhaled corticosteroid until symptoms settle: Immediate swallowing reduces local mucosal contact; temporarily pausing controller treatment risks loss of asthma control, and resuming the same technique leaves the deposition problem uncorrected. Dilute nystatin in water and continue the existing inhaler technique: Dilution reduces local concentration rather than improving contact. Use nystatin before inhaler doses and swallow immediately after administration: This sequencing shortens antifungal contact and does not prevent recurrence. Continue nystatin indefinitely and retain the current inhaled-corticosteroid dose: Treatment duration should be finite and technique, spacer use where appropriate and rinsing can reduce recurrence.
Reference: BNF: nystatin: https://bnf.nice.org.uk/drugs/nystatin/; BNF: beclometasone dipropionate inhaled: https://bnf.nice.org.uk/drugs/beclometasone-dipropionate/