Superficial Candida Infections
Candida albicans is the most common cause of fungal infection. It is a normal commensal organism of the skin, gastrointestinal tract and mucous membranes. Therefore, isolation of C.albicans from asymptomatic patients does not necessarily imply the need for treatment.
Caution:
- Antifungals (azoles especially) can interact with multiple medicines. Contact pharmacy for further advice.
- Avoid fluconazole in pregnancy
For management of oral candidaemia in palliative care patients see HERE
Oral Thrush
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Preferred therapy |
Alternative therapy |
Additional Information |
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Oral thrush - Mild or localised |
Nystatin 100,000units/mL oral suspension 1mL qds. Continue treatment for a further 2 days after lesions have healed |
Miconazole* oral gel 2.5mL qds after meals. Continue for 7 days after symptoms resolved. See MHRA Drug Safety Update contraindicated with concurrent use of statins and warfarin
If unable to have miconazole: Fluconazole 50mg po od for 7 days can extend up to 14 days if symptoms unresolved (avoid in pregnancy) If unable to have fluconazole: Discuss with Micro/ID |
Nystatin suspension may be used in pregnant patients and those with difficulty swallowing or NG tube in situ. Miconazole:
Dentures: Disinfect dentures using chlorhexidine. Rinse denture thoroughly as chlorhexidine and nystatin become ineffective with use in combination. Advise to leave dentures out for at least 6 hours per day to promote healing. |
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Oesophageal candidiasis or Oral thrush - severe or extensive |
Fluconazole 200mg po od for 14 days (avoid in pregnancy) |
If unable to have fluconazole: Discuss with Micro/ID |
Swab to identify causative organism Seek specialist advice for all patients with oesophageal candidiasis. |
Vaginal Thrush
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Preferred therapy |
Alternative therapy |
Additional Information |
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Vaginal thrush - Mild |
Fluconazole 150mg po once only (avoid in pregnancy) |
Clotrimazole pessary 500mg once only PV Add topical clotrimazole 1% cream bd for 14 days for vulval symptoms |
Do not routinely treat an asymptomatic male sexual partner. Sexual partner may require treatment if symptomatic. Complicated cases should be referred to GUM if appropriate. Contact Oxford Sexual Health Service (01865 231231) |
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Vaginal thrush - Severe
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Fluconazole 150mg po on day 1 and day 4 (avoid in pregnancy) |
If unable to have fluconazole: Discuss with Micro/ID |
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Vaginal thrush - Pregnant patient |
Clotrimazole pessary 500mg PV at night for up to 7 consecutive nights. The pessary should be inserted without using an applicator Add topical clotrimazole 1% cream bd for 14 days for vulval symptoms |
If unable to have clotrimazole: Discuss with Micro/ID |
Cutaneous Thrush
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Preferred therapy |
Alternative therapy |
Additional Information |
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Cutaneous candidiasis (e.g. intertrigo, balanitis and nappy rash) |
Careful attention to hygiene and drying may be sufficient |
Clotrimazole 1% cream applied topically bd for up to 14 days |
Consider a steroid-containing topical preparation (e.g. Canestan HC®) for symptom control. |