{ "schema_version": 1, "kind": "condition", "id": "oral-candidiasis", "name": "Oral candidiasis (thrush)", "category": "infectious", "sources": "IDSA Clinical Practice Guideline for Candidiasis 2016 · Egyptian National Drug Formulary - Antimicrobial 2023 (fluconazole monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (itraconazole monograph) · Oral candidiasis (thrush) - disease-level clinical article (oral-candidiasis-clinical.txt) · Daktarin Sugar Free 2% Oral Gel SmPC section 4.2 (eMC product 6597)", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Antimicrobial 2023 (fluconazole monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (itraconazole monograph) · Oral candidiasis (thrush) - disease-level clinical article (oral-candidiasis-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1254, "generic": "Nystatin", "line": 1, "is_adjunct": false, "form": "oral.liquid", "strength_mg": null, "adult_dose": "400,000 to 600,000 units 4 times daily; swish in the mouth and retain before swallowing", "adult_duration": null, "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023", "rationale": "Topical polyene antifungal that binds fungal membrane sterols; first-line for oral thrush given its minimal systemic absorption.", "cautions": [ "Swish around mouth and retain for as long as possible before swallowing.", "Clean teats/pacifiers and treat mother's nipples if breastfeeding infant.", "Nystatin has minimal systemic absorption; GI distress is rare." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children and Adolescents: Oral: 400,000 to 600,000 units 4 times daily; administer half of dose to each side of mouth", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "NOCANDIDA 100.000I.U./ML SUSP. 30 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FUNGIFREE 100000 I.U./ML ORAL DROPS 30 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EUROPEAN EGYPTIAN PHARM. IND.", "price_egp": 6.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MYCOSTATIN 100 000 I.U./ML SUSP. 30ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE > SMITHKLINE BEECHAM", "price_egp": 8.5, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FUNGISTATIN 100 000I.U./ML 30ML SUSP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA", "price_egp": 9.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ORASTATIN 100.000 I.U/ML ORAL SUSP. 30 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEPACO > HI-PHARM", "price_egp": 19.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NYSTATIN 100 000 I.U./ML ORAL SUSP. 30 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 30.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "oral-candidiasis" }, { "id": 1257, "generic": "Clotrimazole", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": null, "adult_dose": "10 mg troche 5 times daily (dissolved over 20 minutes)", "adult_duration": null, "dose_source": "Oral candidiasis (thrush) - disease-level clinical article (oral-candidiasis-clinical.txt)", "rationale": "First-line topical antifungal troche for mild presentation or first presentation of oral candidiasis.", "cautions": [ "Clotrimazole troches are high in sucrose; where there is diabetes or a high risk of dental caries, a once-daily triazole (fluconazole or itraconazole) is the better choice." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Dosing for these regimens should be adjusted according to weight for pediatric patients.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "DERMATIN 1% TOP. POWDER 10 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 4.5, "pack_count": null, "unit_price": null, "strength_mg": 10000.0, "exact_strength": true, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "CANEMAZOLE 1% CREAM 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UP PHARMA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "CANDISTAN 1% TOPICAL CREAM 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > ARAB DRUG COMPANY (ADCO)", "price_egp": 7.25, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "DERMATIN 1% TOPICAL SOLN. 20 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 10.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "DERMATIN 1% TOP. CREAM 14 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 15.0, "pack_count": null, "unit_price": null, "strength_mg": 14000.0, "exact_strength": true, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "LOCASTEN 2% VAGINAL CREAM 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "OTIXLVI 1% TOPICAL SPRAY 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE FACTORY FOR COSMETICS > LA PORTE PHARMA", "price_egp": 60.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "OTIXLVI 1% TOPICAL LOTION 15 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE FACTORY FOR COSMETICS > LA PORTE PHARMA", "price_egp": 69.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "CANDISTAN 1% SOLUTION 20 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 8.25, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "LOCASTEN 1% TOP. SOLUTION 20 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA", "price_egp": 18.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "oral-candidiasis" }, { "id": 1258, "generic": "Miconazole", "line": 1, "is_adjunct": false, "form": "topical", "strength_mg": null, "adult_dose": "2.5 ml of the 2% gel four times a day after meals, held in the mouth as long as possible before swallowing", "adult_duration": "Keep going a week or more beyond the point where the mouth looks clear", "dose_source": "Daktarin Sugar Free 2% Oral Gel SmPC section 4.2 (eMC product 6597)", "rationale": "A gel is what denture stomatitis and angular cheilitis need - it can be smeared on the fitting surface of the denture and on the angles of the mouth, which a suspension or a troche cannot. Oral gel is also the commonest and cheapest miconazole product on an Egyptian pharmacy shelf.", "cautions": [ "Stop it at the first sign of a rash - severe skin reactions including Stevens-Johnson syndrome have been reported with oral gel products.", "The gel is contraindicated in liver dysfunction, and enough is absorbed to raise the effect of warfarin and of oral sulfonylureas - check the patient's other medicines before prescribing.", "Do not smear the gel on the nipple to dose a breastfed baby, and do not apply it to the back of an infant's throat." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Infants 4 to 24 months: 1.25 ml four times a day after meals, each dose split into small portions and smeared on with a clean finger. Never put it at the back of the throat - it can choke a baby. From 2 years the adult 2.5 ml applies.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "MICONOL 2% CREAM 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DERMOZOL 2% GEL 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 6.0, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MICO ORAL 2% ORAL GEL 30 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALFACURE PHARMACEUTICALS", "price_egp": 6.25, "pack_count": null, "unit_price": null, "strength_mg": 30000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BUCCAZOLE 2% ORAL GEL 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 12.0, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MICONAZ 2% ORAL GEL 20 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 23.0, "pack_count": null, "unit_price": null, "strength_mg": 20000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DAKTARIN 2% CREAM 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > JANSSEN CILAG", "price_egp": 28.0, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DAKTARIN 2% ORAL GEL 40 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JANSSEN CILAG > SOFICOPHARM", "price_egp": 53.5, "pack_count": null, "unit_price": null, "strength_mg": 40000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ADCOZOLE 2% TOPICAL CR. 15 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 7.25, "pack_count": null, "unit_price": null, "strength_mg": 15000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "oral-candidiasis" }, { "id": 1255, "generic": "Fluconazole", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 50.0, "adult_dose": "Loading dose of 200 mg on day 1, then 100 to 200 mg once daily", "adult_duration": null, "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (fluconazole monograph)", "rationale": "Triazole antifungal that blocks fungal ergosterol synthesis; used orally for moderate-to-severe thrush or when topical nystatin has failed.", "cautions": [ "Fluconazole is an option for moderate-to-severe thrush or topical treatment failure.", "Caution in hepatic dysfunction.", "The Egyptian formulary gives this regimen - loading dose of 200 mg on day 1, then 100 to 200 mg once daily - for oropharyngeal candidiasis that is moderate to severe (ENDF Antimicrobial 2023, fluconazole monograph).", "Fluconazole has multiple drug interactions via CYP2C9 and CYP3A4 inhibition." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "6 mg/kg on day 1, then 3 mg/kg once daily. The dose halves after day 1 - it is not the same every day. Maximum 100 mg per dose at any age: BNF for Children caps 1 month-11 years at 100 mg, and gives 50-100 mg once daily for 12-17 years.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "1 month to 11 years", "age_min_months": 1, "age_max_months": 143, "dose_text": "6 mg/kg on day 1, then 3 mg/kg once daily. Maximum 100 mg per dose." }, { "label": "12 to 17 years", "age_min_months": 144, "age_max_months": 216, "dose_text": "50 to 100 mg once daily" } ], "peds_doses": null, "brands": [ { "trade_name": "AMRIFLUCAN 50 MG 7 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 24.0, "pack_count": 7, "unit_price": 3.43, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NAVILUCA 50 MG 21 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTERNATIONAL DRUG INDUSTRIES > ROTABIOGEN", "price_egp": 78.75, "pack_count": 21, "unit_price": 3.75, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLOCAZOLE 50 MG 7CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SPIMACO > EIMC", "price_egp": 40.0, "pack_count": 7, "unit_price": 5.71, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRICONAL 50 MG 7 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UP PHARMA", "price_egp": 53.0, "pack_count": 7, "unit_price": 7.57, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DIFLUCAN 50 MG 7 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER", "price_egp": 179.0, "pack_count": 7, "unit_price": 25.57, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DIFLUNAZOLE 25MG/5ML SYRUP 70ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 28.8, "pack_count": null, "unit_price": null, "strength_mg": 25.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "FLUCAZONIL 25MG/5ML SYRUP 70 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 28.8, "pack_count": null, "unit_price": null, "strength_mg": 25.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "oral-candidiasis" }, { "id": 1256, "generic": "Itraconazole", "line": 3, "is_adjunct": false, "form": "oral.solid", "strength_mg": 100.0, "adult_dose": "200 mg once daily without food", "adult_duration": "Not stated in the monograph - treat until clinical resolution, then reassess; prolonged courses need specialist advice", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (itraconazole monograph)", "rationale": "16 live products. The formulary lists oropharyngeal and oesophageal candidiasis as an indication and reserves itraconazole for fluconazole-refractory disease - the option to reach for when nystatin and fluconazole have not worked.", "cautions": [ "Reserve for fluconazole-refractory disease - the formulary says so explicitly.", "The formulary does NOT recommend the capsule for candidiasis; the oral solution is better absorbed. Most Egyptian products are capsules, so absorption is the main reason treatment fails.", "Capsules need stomach acid and food - do not co-prescribe with a PPI or H2 blocker.", "Itraconazole is a strong CYP3A4 inhibitor: check statins (simvastatin is contraindicated), DOACs, calcium channel blockers, vardenafil, and ergot derivatives before prescribing.", "Hepatotoxicity can occur - stop for nausea, anorexia, dark urine or jaundice, and check liver enzymes.", "Recurrent oral thrush in an adult with no inhaled steroid or denture cause needs an HIV and diabetes check, not a stronger antifungal.", "Use with caution in patients with risk factors for heart failure.", "Use with caution in patients with risk factors for heart failure (COPD, renal failure, edematous disorders, ischemic or valvular disease)." ], "peds_mgkg_low": 10.0, "peds_mgkg_high": 10.0, "peds_max_mg": 200.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "Limited data. Infants, children and adolescents: 5 mg/kg every 12 hours (that is 10 mg/kg/day), usual maximum 200 mg/day. Some infections require up to 400 mg/day, which is a specialist decision.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 100, "high_mg": 100, "capped": false }, { "weight_kg": 20, "low_mg": 200, "high_mg": 200, "capped": false }, { "weight_kg": 30, "low_mg": 200, "high_mg": 200, "capped": true }, { "weight_kg": 40, "low_mg": 200, "high_mg": 200, "capped": true } ], "brands": [ { "trade_name": "FUNGITRANAZOLE 100 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY", "price_egp": 32.0, "pack_count": 10, "unit_price": 3.2, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ITRAFUNGIZOLE 100 MG 12 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.", "price_egp": 42.0, "pack_count": 12, "unit_price": 3.5, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FUNGITRANAZOLE 100 MG 4 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY", "price_egp": 15.6, "pack_count": 4, "unit_price": 3.9, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AROZOLE 100MG 4CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALFACURE PHARMACEUTICALS", "price_egp": 19.2, "pack_count": 4, "unit_price": 4.8, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ITRANOX 100 MG 5 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ADWIA", "price_egp": 36.0, "pack_count": 5, "unit_price": 7.2, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ITRAFUNGEX 100 MG 4 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > UTOPIA", "price_egp": 33.0, "pack_count": 4, "unit_price": 8.25, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ITRAPEX 100 MG 4 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 38.0, "pack_count": 4, "unit_price": 9.5, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SPORANOX 100MG 4 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JANSSEN CILAG > SOFICOPHARM", "price_egp": 42.0, "pack_count": 4, "unit_price": 10.5, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "oral-candidiasis" } ] }