How Thrush Is Treated

sticking tongue out
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Oral thrush is a yeast infection of the mouth that can affect babies, children, and adults. It can be mild and go away on its own, needing only for you to keep your mouth clean while using remedies to relieve symptoms. Some people may benefit from consuming active-culture yogurt or beverages or using products such as probiotic pills. Thrush can be treated with prescription antifungal mouthwashes or lozenges if it doesn't resolve on its own.

If those treatments aren't effective, doctors can turn to other antifungal drugs.

Home Remedies and Lifestyle

Oral thrush in babies will often go away without treatment in a week or two, so you may not need to get treatment. Consult your pediatrician to discuss whether active-culture yogurt is appropriate for babies over 6 months old. It provides lactobacilli (probiotic bacteria) to edge out yeast in the mouth

Adults who get a mild case of thrush after taking antibiotics for another reason can also enjoy active-culture yogurt to restore their natural balance between yeast and oral bacteria.

Cold food and drinks can provide relief when you have burning and itching sensations with thrush. Popsicles, ice cream, chilled soups, smoothies, and crushed-ice beverages can temporarily help ease this discomfort. 

You can also use warm salt water rinses (1/2 teaspoon of salt in 1 cup of warm water) for relief.

Be sure kids spit the rinse out when they are done.

Keeping your mouth clean is an important part of treatment. Rinse your mouth with water after you eat and after taking medications (other than medications that are meant to coat the mouth to battle the yeast). Use a soft toothbrush and brush your teeth, gums, and tongue twice a day.

Keep your dentures clean and disinfect them daily. Avoid alcohol-based mouthwashes, as they may exacerbate the burning sensation.

Over-the-Counter (OTC) Therapies

Over-the-counter probiotic pills and active-culture drinks with acidophilus and lactobacilli can help restore friendly bacteria to the mouth and digestive tract. These can be appropriate in mild cases of thrush after the use of antibiotics for other purposes. As a bonus, they help restore the bacteria in your intestinal tract, which is often recommended after antibiotic treatment.

Gentian violet is an older over-the-counter treatment used for thrush in babies and adults, including people with HIV. It is returning to popularity because it is low-cost, safe, and effective.

Gentian violet is swabbed inside the mouth, covering the affected areas. It shouldn't be swallowed, so you need to use caution with babies and young children. It is applied two to three times per day for three days.

It is an antiseptic dye (it is one of the dyes in Gram stain), so it can be messy; it turns the lips and anything else it touches purple. Gentian violet is being further explored for use in places around the world where the prescription drugs used for thrush are impractical or the yeast has begun to develop resistance.

There are some people who have local irritation of the skin and mouth when using gentian violet, and there are rare serious reactions.

Prescriptions

In determining how to treat thrush, your doctor will consider the patient's age, health conditions, the severity of the infection, and whether or not the infection is likely to spread rapidly. If your case if mild to moderate, an antifungal lozenge, mouthwash, or liquid will be the usual treatment. More severe cases will usually be prescribed an oral or intravenous antifungal medication. 

The most common medications for oral thrush include:

  • Mycelex (clotrimazole): This is a topical drug that is prescribed as a lozenge. The medicine is delivered as the lozenge slowly dissolves in the mouth over 20 to 30 minutes. It is usually taken five times a day. It is not recommended for children under age 3.
  • Miconazole: Miconazole gel (applied to the affected areas) may be used for babies older than 4 months, while nystatin is preferred for younger infants. It is used up to four times per day and continued until two days have passed without the symptoms of the infection. Oravig, a miconazole tablet, is available for those age 16 and over. It is placed on the gum above your canine tooth in the morning and slowly dissolves throughout the day.
  • Mycostatin (nystatin): This drug is also commonly prescribed in a lozenge or liquid mouthwash form. For newborns and infants, it is applied with a cotton swab or finger. It is given up to four times per day for all age groups. Direct contact with the medication is needed to fight the yeast. With liquid nystatin, you swish and swallow the medication. For infants, you can use a sterile gauze pad to rub the medication onto the white patches that have active yeast. Some people report that nystatin tastes bitter or acidic, but your pharmacist may be able to add flavoring to it to make it more palatable. Mint flavoring is a popular recommendation as it works well to mask the bitterness.
  • Diflucan (fluconazole): This is usually used as a second line treatment when nystatin proves ineffective. For people who are undergoing chemotherapy, it is most often prescribed in a tablet form taken once daily. Common side effects of Diflucan include headaches, nausea, and dizziness, but these are generally very mild. In some cases, Diflucan may be prescribed to prevent thrush in people who are undergoing cancer treatment. While Diflucan is an excellent drug for treating oral thrush, it can be expensive. Ask for the generic option, fluconazole.

If these prescription drugs prove to be ineffective, or there is a risk of a systemic infection, the doctor may turn to a new class of antifungal medications—echinocandins. These include itraconazole, posaconazole, voriconazole, and amphotericin B, which are administered intravenously.

For the relief of symptoms rather than for treatment, a doctor may prescribe a mouthwash that is a combination of several medications. It is often referred to as magic mouthwash and is often prescribed for thrush that develops during chemotherapy. There are several different formulas and it is at a doctor's discretion to determine which drugs to include and the appropriate dosage. You should not attempt to mix medications at home but leave that work to a pharmacist.

When a nursing baby has thrush, a doctor may prescribe a mild antifungal cream for the mother (to apply to her breasts and nipples) and an antifungal medication for the baby. This is done to prevent passing yeast back and forth. As the baby will be more prone to yeast diaper rash, a baby's bottom should be kept dry and a barrier cream should be used after diaper changes.

Source:

Maley AM, Arbiser JL. Gentian Violet: A 19th Century Drug Re-Emerges in the 21st Century. Experimental Dermatology. 2013;22(12):775-780. doi:10.1111/exd.12257.

Oral Complications of Chemotherapy and Head/Neck Radiation—Patient Version (PDQ). National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/side-effects/mouth-throat/oral-complications-pdq.

Oral Thrush. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/oral-thrush/diagnosis-treatment/drc-20353539.

Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 2016;62(4):e1-e50. doi:10.1093/cid/civ933.

Thrush in Newborns. MedlinePlus. https://medlineplus.gov/ency/article/007615.htm.