Oral Thrush

Question 1

What is oral thrush and its cause?

Answer 1

An infection caused by fungal Candida albicans
also causes nappy rash and vaginal thrush
Oral thrush: affects tongue surface and inside of cheeks

Question 2

Oral thrush presenting symptoms

Answer 2

• sore mouth
• white ‘milk’ flecks on the tongue/cheeks, can’t be wiped off. If scraped off, could lead to inflamed red patches and bleeding
• cracks in the mouth
• painful burning sensation`

Question 3

Danger elimination questions/red flag symptoms

Answer 3

-Failed medication
-Diabetics
-painless lesions
-recurrent oral thrush/thrush of other areas after neonatal period: possibly first signs of HIV infection
Other considerations:
-is patient on antibiotic? They might have wiped out normal flora
-asthmatic patient? May be caused by ICS inhaler
-breastfeeding mother?

Question 4

If a baby has oral thrush, what must you do as a pharmacist?

Answer 4

check if nappy rash is also present
Both should be treated at the same time
Antifungal cream containing miconazole or clotrimazole can be used for the nappy area

Question 5

Oral thrush age considerations

Answer 5

common in newborns (pick up infection in birth canal)

Question 6

How common is recurrent oral thrush?

Answer 6

Uncommon, unless baby is drinking from poorly sterilised bottles or if the infection comes from the mother’s nipples

Question 7

Lifestyle advice

Answer 7

-Inhaled steroids - rinse throat with water after using inhaler. Use spacer with inhaler
Switch to breath-actuated inhaler which will improve inhaler technique
-Breastfeeding mothers can apply small amounts of miconazole gel to the nipples - to eradicate any fungus present.
-for bottle-fed babies, sterilise bottles and teats effectively

Question 8

Treatment timescale of oral thrush

Answer 8

If no improvement of symptoms after 7 days of treatment, refer to GP

Question 9

Name 2 treatments for oral thrush

Answer 9

Miconazole gel 2% (Daktarin sugar free gel)

Antibacterial mouthwash - chlorhexidine

Question 10

Describe the directions for use of daktarin sugar free antifungal gel for oral thrush
(miconazole)

Answer 10

Adults and those over 2 years of age: apply 2.5mL of gel directly to affected area with a clean finger, QDS after meals
4-24 months: apply a small amount of gel (1.25mL) QDS after meals

Keep in contact with affected area for as long as possible
continue for 2 days until clear

Question 11

Side effects of miconazole gel 2% (for oral thrush)

Answer 11

sudden swelling of face, lips, tongue or throat due to allergy
skin rash: discontinue at first appearance of skin rash

Question 12

Warnings of miconazole gel 2% for oral thrush

Answer 12

Not recommended for patients taking anticoagulants
Caution in breastfeeding Do NOT apply to the nipple for administration to a child
Caution required: ensure gel does NOT obstruct the throat
Not for use in pregnancy
Caution in breastfeeding women

Question 13

Miconazole gel 2% for oral thrush

counselling

Answer 13

• Apply gel after food
• For babies, gel can be applied directly to the lesions using a cotton bud or the handle of a tea spoon
• Gel should remain in the mouth for as long as possible.

Question 14

Antibacterial mouthwash for oral thrush

active ingredient and instructions

Answer 14

Chlorhexidine
Rinse mouth with 10mls BD
Use it until 2 days after the symptoms have gone

Question 15

Side effects of chlorhexidine mouth wash for oral thrush

Answer 15

dry mouth
mouth irritation
tooth or tongue staining (brown)
unusual or unpleasant taste in mouth
decreased taste or change in taste

Question 16

Chlorhexidine mouthwash for oral thrush - is it ok for pregnant women to take?

Answer 16

Yes

Question 17

Chlorhexidine mouthwash for oral thrush counselling

Answer 17

brush teeth beforehand to reduce the chance of brown staining of teeth
use after tooth brushing