Introduction

Oropharyngeal candidiasis (OPC), or candidiasis of the mouth and throat, is more commonly known as "thrush". It's a fungal infection caused by Candida albicans , which is normally found on the skin or mucous membranes. If there are changes in the body's defense mechanisms, Candida can increase rapidly, causing the symptoms of thrush to appear.

OPC occurs most frequently and more severely in people with weakened immune systems - those with blood cancer, those being treated with chemotherapy and/or irradiation, and persons with HIV or AIDS infection. It's sometimes seen in people taking prolonged antibiotics, inhaled steroids (for asthma), in diabetics, and in denture wearers.

OPC can also affect normal newborn infants, but this isn't discussed further here. Candidiasis is often considered a cause of vague generalized illness with multiple symptoms, similar to the chronic fatigue syndrome, for which numerous alternative medicine therapies (herbs, minerals, supplements, etc) are consumed.

This article is only about approved medical treatments for OPC. It summarizes the clinical trials that have been done to determine which medicines work best.

Preventing OPC

Obvious precautionary steps include rinsing your mouth after using inhaled steroids for asthma, and avoiding unnecessary antibiotics; if antibiotics have to be taken repeatedly, consider eating live yogurts or preparations containing the same sort of micro-organisms.

Two main classes of drugs have been found to be effective in preventing OPC: azoles and polyenes. The azoles include fluconazole, ketoconazole, miconazole, itraconazole, and clotrimazole; all have been found effective in preventing attacks of OPC in susceptible individuals. Two polyenes - amphotericin B and nystatin - have been proved effective in preventing OPC in people with damaged immune systems. In general, the azoles are somewhat more effective than the polyenes.

These medicines may be taken as tablets, capsules, lozenges, or suspensions. Another chemical, chlorhexidine, can be used as an oral rinse. Normally taken daily, azoles may sometimes be taken once-weekly. Weekly use is only slightly less effective in preventing attacks of OPC, and is obviously a more convenient regime.

Side effects of these drugs are not a problem. About 5% of patients report occasional abdominal pain, nausea, vomiting, or a rash.

Treating OPC

Most azole drugs (fluconazole, ketoconazole, itraconazole) and the polyene amphotericin B are effective in treating attacks of OPC. They can be given as tablets or capsules, when the drug is absorbed into the body, or as pastilles or lozenges, when the effect is produced directly on the lesions in the mouth and throat.

In general, there are no differences in effectiveness between these drugs or the way they are administered (e.g. tablets vs. lozenges). However, clotrimazole, miconazole, and nystatin are not well absorbed into the body, and should only be used topically - i.e. suspension, gel, or lozenge forms.

Treating OPC in children

Immunocompromised children (i.e. those with HIV infection, cancer, or having immunosuppressive treatment) who have OPC can be treated in the same way as adults (with appropriate lower doses).

For treating thrush in babies, please see the first link below.

Comment

Oropharyngeal candidiasis can be treated effectively with medicines that are prescribed by your doctor. Also, these medicines can be used to prevent the occurrence of OPC in patients at high risk, given daily or once-weekly.

OPC is a well-defined condition that can easily be diagnosed and effectively treated by your health professional. It should not be confused with the vague syndrome "candidiasis hypersensitivity" or "yeast allergy", which is often used to describe a collection of symptoms such as: fatigue, irritability, constipation, diarrhea, abdominal bloating, mood swings, depression, anxiety, dizziness, psoriasis, menstrual problems, bladder infections, and "feeling bad all over"; this condition is similar to others that have their foundation in patients' gullibility rather than clinical facts.

Source

Oropharyngeal candidiasis
C. Pankhurst, Clin Evid, 2002, vol. 7, pp. 1248--1262

Links

• Baby Centre: Thrush in Babies
• CDC Information: Oropharyngeal Candidiasis (OPC, Thrush)
• Oral or Intra-Vaginal Tablets for Thrush?
• Disease Digest: Herpes Simplex
• Disease Digest: Periodontal Disease