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Palliative cancer care - oral problems - Management
Which topical antifungal is recommended?
- Topical nystatin or topical miconazole are recommended for first-line treatment of oral candida infection.
Basis for recommendation
- Few trials have compared the use of topical anticandidal treatments in people with cancer in palliative care [Pankhurst, 2005].
- Nystatin is recommended as it only needs to be prescribed for 7 days and resistance to nystatin is uncommon [Davies and Finlay, 2005].
- Miconazole also only needs to be prescribed for 7 days it is an imidazole antifungal which provides a different therapeutic option to nystatin as it belongs to a different antifungal class. However, resistance to miconazole is becoming increasingly common, especially in people who are immunocompromised [Davies and Finlay, 2005].
- Amphotericin is not recommended as it needs to be prescribed for 14 days and as like nystatin it is a polyene antifungal, it therefore offers no therapeutic advantage over nystatin.
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