oral thrush

Question 1

what are the symptoms of oral thrush?

Answer 1

o Can vary significantly, some cases are severe whilst others are asymptomatic o Sore and painful mouth
o Burning tongue
o Altered taste
o Cracks on the mouth

Question 2

who is oral thrush common in?

Answer 2

o Babies and infants: if a baby has oral thrush, check if nappy rash is also present
as both should be treated at the same time o People using steroid inhalers
o Older people that wear dentures

Question 3

what are the red flags for oral thrush”

Answer 3

• Recurrent infection
o Recurrent oral thrush after the neonatal period can possibly be the first signs of
immunodeficiency such as a HIV infection
• Diabetic patients
o May need a review of their current medication to achieve better control of their blood glucose levels
• Symptoms unresponsive to treatment after 7 days
• Babies under the age of 4 months, as miconazole is not licensed OTC

Question 4

what is the lifestyle advice for oral thrush?

Answer 4

• For patients who take inhaled steroids, they can reduce the likelihood of oral thrush infections via the use of a spacer and by rinsing their throat out with water after using their inhaler. A breath-actuated inhaler may also be a suitable change if the patient has poor inhaler technique
• Sterilising bottles and teats for bottle-fed babies helps minimise the risk of reinfection
• Breastfeeding mothers can apply a small amount of miconazole gel to their nipples in other
to prevent their baby getting a reinfection when not breastfeeding
• Dentures should be removed before treatment with miconazole gel

Question 5

how should miconazole 2% gel be used?

Answer 5

• 4-24 months: 1.25ml QDS after meals
• 2+ years and adults: 2.5ml QDS after meals
• Apply gently directly to lesions using a cotton bud or clean finger up to 4 times a day. Try
to keep the gel in contact with the affected area. Continue use for 2 days until clear.

Question 6

when should miconazole 2% gel be stopped?

Answer 6

o At the first sight of a skin rash or sudden swelling of the face, lips, tongue, or throat (allergic response)
o If patient experiences nosebleeds, bruising, bleeding, coughing up blood, blood in urine, black stools or “coffee ground” vomit

Question 7

who is miconazole 2% gel not recommended for?

Answer 7

o Babies under the age of 4 months due to the potential risk of ingestion and choking
hazard of the gel
o Patients taking anticoagulants, oral hypoglycaemics, phenytoin o Pregnant women
o Patients with liver dysfunction