Oral thrush / candidiasis



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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)




  1. Immediate management: not applicable




  1. 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



  1. 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




Schedule

3

Nystatin

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

Form

Strength

Route of Administration

Recommended Dosage

Duration

Suspension

100,000 units/mL

Oral

1 mL 6-hourly

swished around mouth for 30 seconds then swallowed. Use after eating / not before



7 to 14 days

If breast feeding treat nipples



Provide Consumer Medicine Information:

Management of Associated Emergency: Consult MO
[6] or


Schedule

3

Miconazole

DTP

IHW / SRH / IPAP / NP



Sexual and Reproductive Health Program Endorsed Registered Nurses/ Authorised Indigenous Health Workers and Isolated Practice Area Paramedic may proceed

Nurse Practitioners may proceed

Form

Strength

Route of Administration

Recommended Dosage

Duration

Oral gel

2%

Oral

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


7-14 days (measuring spoon supplied with pack)

If breast feeding treat nipples



Provide Consumer Medicine Information: Miconazole can potentiate the effect of warfarin [6]

Management of Associated Emergency: Consult MO

[3]



  1. 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




  1. Referral / Consultation:



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