Download Oral Thrush / Candidiasis


Oral thrush / candidiasis
Background
 There are different clinical presentations of oral candidiasis
 creamy white patches – (pseumomembranous candidosis) are easily removed
and leave red inflamed mucosa
 tender red mucosa after antibiotics (acute erythematous candidosis) and chronic
candidiasis from e.g. ill fitting dentures, immunosuppression
 fixed lesion on the oral mucosa – usually white (hyperplastic candidosis) can
sometimes clinically resemble oral cancer. Biopsy may be required to exclude
oral cancer [6]
1.
May present with:
 In infant discrete white patches that are easily removed (bleed on removal) and resemble milk curd
 The patches may join and are found on the tongue, roof of mouth, inside the cheeks and on the
gums
 Severe cases may show ulceration
 May present as irritable infant or feeding problem
 Person with ill fitting dentures
 History of taking medication (antibiotic, inhaled or systemic corticosteroids) [6]
 Person with immunosuppression illness eg leukaemia, HIV [6]
 White fixed lesion (with or without history of smoking / alcohol use)
2.
Immediate management: not applicable
3.
Clinical assessment:
 Obtain patient history including
 current medications – particularly oral / inhaled steroids, antibiotics
 medical history, past episodes of candidiasis
 dental history
 Perform standard clinical observations (oral candidiasis is uncommon in healthy individuals)
 Perform physical examination

inspect oral cavity – are the patches easily removed or are they fixed?

inspect infant’s nappy area for candidiasis

inspect mothers nipples for evidence of candidiasis
4.
Management:
 Consult MO (or Child Health Nurse if condition in children) if severe
 Treat with Miconazole gel or Nystatin drops
 If breastfeeding treat nipples also
 Advise denture wearers with oral candidiasis to apply the antifungal gel / drops to the cleaned fitting
surface of the dentures before inserting them [6]. At night, dentures should be removed, cleaned
thoroughly, and twice weekly soaked in white vinegar (diluted 1:20) or 1% solution of common
bleach
 Educate regarding cleaning and sterilisation of teats and dummies, dentures
 Those with severe candidiasis or immunocompromised patients may require systemic antifungal
drugs
 Consult MO if oral candidiasis in adult to exclude oral cancer
DTP
IHW / SRH / NP / IPAP
Sexual and Reproductive Health Program Endorsed Registered Nurses, Authorised Indigenous Health Workers and Isolated
Practice Area Paramedic may proceed
Nurse Practitioners may proceed
Route of
Form
Strength
Recommended Dosage
Duration
Administration
Suspension
100,000
Oral
1 mL 6-hourly
7 to 14 days
units/mL
swished around mouth for 30 seconds
If breast feeding treat
then swallowed. Use after eating / not
nipples
before
Provide Consumer Medicine Information:
Management of Associated Emergency: Consult MO
Schedule
3
Nystatin
[6] or
DTP
IHW / SRH / IPAP / NP
Sexual and Reproductive Health Program Endorsed Registered Nurses/ Authorised Indigenous Health Workers and Isolated
Schedule
3
Miconazole
Practice Area Paramedic may proceed
Nurse Practitioners may proceed
Route of
Form
Strength
Administration
Oral gel
2%
Oral
Recommended Dosage
Child. 6 months to 2 years: 1.25mL
4 times a day
Children and adults: > 2 years: 2.5mL
orally, 4 times a day.
Use after eating - place directly in
mouth and on tongue
Provide Consumer Medicine Information: Miconazole can potentiate the effect of warfarin [6]
Management of Associated Emergency: Consult MO
[3]
5.
Follow up:
 If mild, review in one week
 If moderate, review daily initially
 Consult Child Health Nurse if child or infant
 Consult MO if severe or not improving
6.
Referral / Consultation:
 Consult MO or Child Health Nurse as above
Duration
7-14 days
(measuring spoon
supplied with pack)
If breast feeding
treat nipples