Recommended first-line treatments for oral thrush in immunocompetent patients are topical antifungal agents, specifically miconazole oral gel or nystatin suspension. Miconazole oral gel is preferred as first-line treatment due to evidence suggesting it is more effective than nystatin for oral candidiasis. Treatment should continue for at least 7 days after lesions have healed or symptoms have cleared.
If miconazole is unsuitable, nystatin suspension is recommended as an alternative, with treatment for 7 days and continued for 48 hours after lesions resolve.
For persistent or extensive infection, or if topical treatment is not effective or suitable, oral fluconazole is recommended, typically at 50 mg daily for 7-14 days.
In immunocompromised patients, high-dose oral fluconazole is generally preferred as first-line treatment.
Additional management includes addressing predisposing local and systemic risk factors, good oral hygiene, denture care with chlorhexidine cleaning, and lifestyle advice such as smoking cessation and proper inhaler technique if relevant.
If oral candidiasis persists despite treatment, specialist advice should be sought.
References: NICE CKS, NICE CKS