OTC - oral thrush

Question 1

Symptoms?

Answer 1

• common in babies

- white patches on tongue and mucosal surfaces inside mouth - may scratch off and reveal red/sore underneath, may bleed

Question 2

Referral?

Answer 2

• all except babies (less common in adults unless they are taking a steroid inhaler)
• recurrent infection
• symptoms unresponsive to treatment (otc failure >1 week)

Question 3

OTC product and directions for use?

Answer 3

• miconazole oral gel (daktarin 2%)
• 4 months+
• apply 4 times a day after meals
• continue for at least 1 week after symptoms disappear
• do not apply gel to back of throat - possible choking

Question 4

Miconazole significant interaction?

Answer 4

WARFARIN –> bleeding risk

*alternative = nystatin 100,000 units 4 times a day for 7 days and continued for 48 hours after lesions have resolved

Question 5

Advice?

Answer 5

• high dose ICS: encourage patients to use a spacer, rinse mouth out after use and correct inhaler technique
• treat nappy rash if also present
• prevent re-infection: sterilize bottle teats
• if breastfeeding apply miconazole cream to nipple and wipe away before a feed