# Oral candidiasis (thrush) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - 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) - Verified date: 2026-08 ## 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) ## Treatment metadata - Nystatin — oral.liquid - Clotrimazole — oral.solid - Miconazole — topical - Fluconazole — 50 mg — oral.solid - Itraconazole — 100 mg — oral.solid ## Complete treatment card ```text ORAL CANDIDIASIS (THRUSH) 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 against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - A burning sensation in the mouth along with occasional bleeding and altered taste can occur with oral thrush [bleeding · taste disturbance] - Denture-related candidiasis is often symptom-free, though some patients report a sore or burning mouth - Angular cheilitis causes painful, sore lesions at the corners of the mouth SIGNS - what you find (9) - Oral thrush shows widespread white patches that wipe off with gauze, leaving red mucosa underneath - Hyperplastic candidiasis forms raised, well-defined white plaques, usually on the inner cheek [plaques] - Unlike ordinary thrush, hyperplastic candidiasis plaques cannot be wiped away [plaques] - Acute atrophic candidiasis shows widespread or patchy redness, most often on the palate [atrophy · redness] - Denture stomatitis shows redness of the mucosa limited to the area the denture covers [redness] - Median rhomboid glossitis is a diamond-shaped red patch on the back-center of the tongue, in front of the circumvallate papillae - A mirror-image red patch on the palate opposite a tongue lesion often signals underlying immune suppression - Angular cheilitis appears as cracked, red patches at the mouth corners, usually on both sides [redness] - Linear gingival erythema is a red line or band along the gum margin of one or more teeth [redness] TESTS (5) - Diagnosis is usually made clinically from the lesion's appearance, history, and response to antifungal treatment - Biopsy is advised for the atrophic and hyperplastic forms because they can resemble premalignant or malignant lesions - Culture and sensitivity testing are used when antifungal treatment does not work - When denture stomatitis is suspected, samples are taken from both the denture and the palate, since mucosal sampling alone can miss it - An underlying immune-suppressing condition such as HIV, diabetes, or steroid use should also be tested for IF NOT THIS - what else fits (4) - Thermal burns, erythema migrans, and anemia can mimic the red form of candidiasis, alongside oral mucositis and erythroplakia - Chronic hyperplastic candidiasis can be confused with leukoplakia, lichen planus, pemphigoid, pemphigus, or squamous cell carcinoma - Oral hairy leukoplakia, an Epstein-Barr virus-driven lesion, is also on the differential - Herpes gingivostomatitis and herpes labialis are also on the differential for white or red oral lesions Source StatPearls "Oral Candidiasis" - disease-level clinical article Status traced to the source above Rx: Nystatin | Clotrimazole | Oral gel - the option for angular cheilitis and denture stomatitis | Main treatment NYSTATIN 1. NYSTATIN [1st line] Adult 400,000 to 600,000 units 4 times daily; swish in the mouth and retain before swallowing Peds Children and Adolescents: Oral: 400,000 to 600,000 units 4 times daily; administer half of dose to each side of mouth Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Topical polyene antifungal that binds fungal membrane sterols; first-line for oral thrush given its minimal systemic absorption. Caution 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. Egypt NOCANDIDA 100.000I.U./ML SUSP. 30 ML PHAROPHARMA 5.00 EGP FUNGIFREE 100000 I.U./ML ORAL DROPS 30 ML EUROPEAN EGYPTIAN PHARM. IND. 6.00 EGP MYCOSTATIN 100 000 I.U./ML SUSP. 30ML GLAXO SMITHKLINE > SMITHKLINE BEE... 8.50 EGP FUNGISTATIN 100 000I.U./ML 30ML SUSP. DELTA PHARMA 9.00 EGP ORASTATIN 100.000 I.U/ML ORAL SUSP. 30 ML MEPACO > HI-PHARM 19.00 EGP NYSTATIN 100 000 I.U./ML ORAL SUSP. 30 ML EIPICO 30.00 EGP CLOTRIMAZOLE 2. CLOTRIMAZOLE [1st line] Adult 10 mg troche 5 times daily (dissolved over 20 minutes) Peds Dosing for these regimens should be adjusted according to weight for pediatric patients. Source Oral candidiasis (thrush) - disease-level clinical article (oral-candidiasis- clinical.txt) Why First-line topical antifungal troche for mild presentation or first presentation of oral candidiasis. Caution 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. Egypt DERMATIN 1% TOP. POWDER 10 GM PHARCO 4.50 EGP -> ? different route - not oral solid CANEMAZOLE 1% CREAM 20 GM UP PHARMA 5.00 EGP -> ? different route - not oral solid CANDISTAN 1% TOPICAL CREAM 15 GM KAHIRA > ARAB... 7.25 EGP -> ? different route - not oral solid DERMATIN 1% TOPICAL SOLN. 20 ML PHARCO 10.00 EGP -> ? different route - not oral solid DERMATIN 1% TOP. CREAM 14 GM PHARCO 15.00 EGP -> ? different route - not oral solid LOCASTEN 2% VAGINAL CREAM 20 GM ALEXANDRIA 29.00 EGP -> ? different route - not oral solid OTIXLVI 1% TOPICAL SPRAY 60 ML EL NILE FACTO... 60.00 EGP -> ? different route - not oral solid OTIXLVI 1% TOPICAL LOTION 15 ML EL NILE FACTO... 69.00 EGP -> ? different route - not oral solid CANDISTAN 1% SOLUTION 20 ML ARAB DRUG COM... 8.25 EGP -> ? strength differs, ? different route - not oral solid LOCASTEN 1% TOP. SOLUTION 20 ML ALEXANDRIA 18.00 EGP -> ? strength differs, ? different route - not oral solid ORAL GEL - THE OPTION FOR ANGULAR CHEILITIS AND DENTURE STOMATITIS 3. MICONAZOLE [1st line] Adult 2.5 ml of the 2% gel four times a day after meals, held in the mouth as long as possible before swallowing - Keep going a week or more beyond the point where the mouth looks clear Peds 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. Source Daktarin Sugar Free 2% Oral Gel SmPC section 4.2 (eMC product 6597) Why 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. Caution 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. Egypt MICONOL 2% CREAM 15 GM MEMPHIS 5.00 EGP DERMOZOL 2% GEL 15 GM PHARCO 6.00 EGP MICO ORAL 2% ORAL GEL 30 GM ALFACURE PHAR... 6.25 EGP BUCCAZOLE 2% ORAL GEL 20 GM PHARCO 12.00 EGP MICONAZ 2% ORAL GEL 20 GM MUP 23.00 EGP DAKTARIN 2% CREAM 15 GM MINA PHARM > ... 28.00 EGP DAKTARIN 2% ORAL GEL 40 GM JANSSEN CILAG... 53.50 EGP ADCOZOLE 2% TOPICAL CR. 15 GM ARAB DRUG COM... 7.25 EGP MAIN TREATMENT - choose one 4. FLUCONAZOLE [2nd line] Adult Loading dose of 200 mg on day 1, then 100 to 200 mg once daily Peds 1 month to 11 years: 6 mg/kg on day 1, then 3 mg/kg once daily. Maximum 100 mg per dose. 12 to 17 years: 50 to 100 mg once daily (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.) Source Egyptian National Drug Formulary - Antimicrobial 2023 (fluconazole monograph) Why Triazole antifungal that blocks fungal ergosterol synthesis; used orally for moderate- to-severe thrush or when topical nystatin has failed. Caution 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. Egypt AMRIFLUCAN 50 MG 7 CAPS. AMRIYA 24.00 EGP (3.43/unit) NAVILUCA 50 MG 21 CAPS. INTERNATIONAL... 78.75 EGP (3.75/unit) FLOCAZOLE 50 MG 7CAPS. SPIMACO > EIMC 40.00 EGP (5.71/unit) TRICONAL 50 MG 7 CAPS. UP PHARMA 53.00 EGP (7.57/unit) DIFLUCAN 50 MG 7 CAPS. PFIZER 179.00 EGP (25.57/unit) DIFLUNAZOLE 25MG/5ML SYRUP 70ML CID 28.80 EGP -> ? strength differs, ? different route - not oral solid FLUCAZONIL 25MG/5ML SYRUP 70 ML EL NILE. 28.80 EGP -> ? strength differs, ? different route - not oral solid 5. ITRACONAZOLE [3rd line] Adult 200 mg once daily without food - Not stated in the monograph - treat until clinical resolution, then reassess; prolonged courses need specialist advice Peds 10 mg/kg/day [child max 200 mg] (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.) 3kg -> 30 mg/day 4kg -> 40 mg/day 5kg -> 50 mg/day 6kg -> 60 mg/day 7kg -> 70 mg/day 8kg -> 80 mg/day 9kg -> 90 mg/day 10kg -> 100 mg/day 11kg -> 110 mg/day 12kg -> 120 mg/day 13kg -> 130 mg/day 14kg -> 140 mg/day 15kg -> 150 mg/day 16kg -> 160 mg/day 17kg -> 170 mg/day 18kg -> 180 mg/day 19kg -> 190 mg/day 20kg -> 200 mg/day 21kg -> 200 mg/day (capped) 22kg -> 200 mg/day (capped) 23kg -> 200 mg/day (capped) 24kg -> 200 mg/day (capped) 25kg -> 200 mg/day (capped) 26kg -> 200 mg/day (capped) 27kg -> 200 mg/day (capped) 28kg -> 200 mg/day (capped) 29kg -> 200 mg/day (capped) 30kg -> 200 mg/day (capped) 31kg -> 200 mg/day (capped) 32kg -> 200 mg/day (capped) 33kg -> 200 mg/day (capped) 34kg -> 200 mg/day (capped) 35kg -> 200 mg/day (capped) 36kg -> 200 mg/day (capped) 37kg -> 200 mg/day (capped) 38kg -> 200 mg/day (capped) 39kg -> 200 mg/day (capped) 40kg -> 200 mg/day (capped) 41kg -> 200 mg/day (capped) 42kg -> 200 mg/day (capped) 43kg -> 200 mg/day (capped) 44kg -> 200 mg/day (capped) 45kg -> 200 mg/day (capped) 46kg -> 200 mg/day (capped) 47kg -> 200 mg/day (capped) 48kg -> 200 mg/day (capped) 49kg -> 200 mg/day (capped) 50kg -> 200 mg/day (capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 (itraconazole monograph) Why 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. Caution 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). Egypt FUNGITRANAZOLE 100 MG 10 CAPS. DEBEIKY 32.00 EGP (3.20/unit) ITRAFUNGIZOLE 100 MG 12 CAPS. AL ROWAD PHAR... 42.00 EGP (3.50/unit) FUNGITRANAZOLE 100 MG 4 CAPS. DEBEIKY 15.60 EGP (3.90/unit) AROZOLE 100MG 4CAPS. ALFACURE PHAR... 19.20 EGP (4.80/unit) ITRANOX 100 MG 5 CAPS. ADWIA 36.00 EGP (7.20/unit) ITRAFUNGEX 100 MG 4 CAPS. FUTURE PHARMA... 33.00 EGP (8.25/unit) ITRAPEX 100 MG 4 CAPS. MULTI-APEX 38.00 EGP (9.50/unit) SPORANOX 100MG 4 CAPS. JANSSEN CILAG... 42.00 EGP (10.50/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)