Oral candidiasis

Prescribing Notes:

• In unexplained oral candidiasis HIV testing should be offered.
• Consider use of spacer device, rinse mouth and clean teeth if oral thrush is related to inhaled corticosteroids.

Prescribing Notes:

• Evidence of oral thrush in a breast-fed baby should prompt initiation of simultaneous treatment of both mother and baby. In breast feeding mothers oral thrush in the infant can easily spread to the mother, simultaneous treatment of mother (topical treatment) and baby oral treatment with miconazole is recommended.
• The Summary of Product Characteristics for miconazole oral gel states that use in children aged under 4 months is contraindicated. However, the BNF for Children does not list this as a contraindication and states that use in children aged under 4 months or during the first 5–6 months of life of an infant born pre-term is unlicensed, and provides dosage information for neonates. Oral miconazole is contra-indicated in infants with impaired swallowing reflex.
• In unexplained oral candidiasis HIV testing should be offered.
• Consider use of spacer device, rinse mouth and clean teeth if oral thrush is related to inhaled corticosteroids.
• For prescribers in NHS Lothian for more information refer to NHS Lothian RefHelp Breastfeeding Thrush guidance.

Prescribing Notes:

• Avoid concomitant use in patient taking interacting medicines as per BNF e.g. warfarin, simvastatin and sulphonylureas.
• Dental prostheses should be removed at night and brushed with gel.
• Miconazole oral gel is not licensed in children under 4 months of age.
• Pre-term or slower developing babies should not be given miconazole gel until they are 5-6 months old, as detailed in the product literature.
• Never put a large portion of gel in the back of the throat.
• If patient uses an inhaled corticosteroid, advise them to rinse mouth after use and check their inhaler technique.
• Caution: Miconazole can enhance the anticoagulant effect of warfarin and should never be sold to patients taking warfarin. There are other, much safer, options to treat oral thrush in patients taking oral anticoagulants which will require referral to a Prescriber to obtain.

Examples of Counselling Points
Treatment should be continued for 48 hours after the lesions have healed.
If patient uses an inhaled corticosteroid, advise patient to rinse mouth after use. Check inhaler technique.
If patient wears dentures, advise to leave dentures out as much as possible until infection has cleared.

When to advise patient to contact GP
Child under 4 months.
Duration of longer than 3 weeks.
Associated weight loss.
Involvement of other mucous membranes.
Rash.
Suspected adverse drug reaction.
Diarrhoea.
Patients on warfarin.