Candidosis

Pseudomembranous candidosis and erythematous candidosis

• Patients predisposed to these infections include those taking inhaled corticosteroids, cytotoxics or broad-spectrum antibacterials, patients with diabetes, patients with nutritional deficiencies, or patients with serious systemic disease associated with reduced immunity.
• Where possible, predisposing factors or conditions should be managed to reduce the risk of infection; this may involve referral to a specialist or liaising with the patient's general medical practitioner.
• Miconazole oral gel is recommended for topical treatment of mild and localised infections. If this is contraindicated, nystatin oral suspension may be given. Systemic antifungal treatment with fluconazole is appropriate for patients with severe or extensive infection or for whom topical treatment is unsuitable or ineffective, unless otherwise contraindicated.
• If the patient does not respond to appropriate local measures and a course of drug treatment, or there is no identifiable cause, refer the patient to a specialist or the patient’s general medical practitioner for further investigation.
• Fungal infections in immunocompromised patients with serious systemic disease are likely to need longer courses of treatment or intravenous systemic treatment; therefore, refer such patients urgently to a specialist or to the patient’s general medical practitioner.
• Candidosis in children is often related to local risk factors (e.g. orthodontic appliances) and responds well to local measures and topical antifungal agents. If the patient does not respond, consider referring them to a specialist or to their general medical practitioner for further investigation.