Fungal infections

Superficial fungal infections can be treated in a primary care setting.

Miconazole oral gel is recommended for topical treatment of mild and localised infections. If this is contraindicated (see below), nystatin oral suspension may be given. Note that compliance with nystatin can be poor because of its unpleasant taste.

Chlorhexidine mouthwash is also effective against fungal infections.

For more extensive or severe infection, or when miconazole or nystatin treatment is unsuitable or ineffective, the systemically absorbed drug fluconazole can be prescribed unless contraindicated. 

Note that fluconazole interacts with many drugs, including warfarin and statins, and therefore do not give fluconazole to patients taking these drugs. In addition, avoid the use of miconazole, a topical azole antifungal agent, in such patients because sufficient drug is absorbed to cause similar interactions.

There is conflicting evidence about whether chronic hyperplastic candidosis (candidal leukoplakia) is potentially premalignant. However, these patients should be referred for specialist assessment and treatment.