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Candida - oral - Management
How should I treat a person who is receiving immunosuppressant drugs?
- Seek specialist advice before prescribing antifungal treatment for people:
- Taking ciclosporin or oral tacrolimus (especially if these drugs are being used to suppress tissue rejection following transplantation).
- Receiving chemotherapy.
- For people taking oral corticosteroids or disease-modifying anti-rheumatic drugs (DMARDs):
- If oral candidiasis is mild and localized, prescribe topical treatment for 7 days (continue for 2 days after symptoms resolve):
- If oral candidiasis is extensive or severe, prescribe oral fluconazole 50 mg to 100 mg a day, for 7 days.
- If there is suspicion that DMARDs are causing marked immunosuppression, seek specialist advice and ensure blood parameters are being adequately monitored (see the CKS topic on DMARDs).
- Follow up all people after 7 days of treatment.
- Advise good dental hygiene and to give up smoking if applicable (see the CKS topic on Smoking cessation).
- The following treatments are not recommended for initiation in primary care:
- Miconazole mucoadhesive buccal tablets.
- Oral itraconazole.
- Oral ketoconazole.
- Oral amphotericin.
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