Dawaa Reference

infectious

Oral candidiasis (thrush)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

IDSA Clinical Practice Guideline for Candidiasis 2016 · Egyptian National Drug Formulary - Antimicrobial 2023 (fluconazole monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (itraconazole monograph) · Oral candidiasis (thrush) - disease-level clinical article (oral-candidiasis-clinical.txt) · Daktarin Sugar Free 2% Oral Gel SmPC section 4.2 (eMC product 6597)

Verified against3 documents
  • Egyptian National Drug Formulary - Antimicrobial 2023 (fluconazole monograph)
  • Egyptian National Drug Formulary - Antimicrobial 2023 (itraconazole monograph)
  • Oral candidiasis (thrush) - disease-level clinical article (oral-candidiasis-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (3)

  • A burning sensation in the mouth along with occasional bleeding and altered taste can occur with oral thrush [bleeding · taste disturbance]
  • Denture-related candidiasis is often symptom-free, though some patients report a sore or burning mouth
  • Angular cheilitis causes painful, sore lesions at the corners of the mouth

Signs — what you find (9)

  • Oral thrush shows widespread white patches that wipe off with gauze, leaving red mucosa underneath
  • Hyperplastic candidiasis forms raised, well-defined white plaques, usually on the inner cheek [plaques]
  • Unlike ordinary thrush, hyperplastic candidiasis plaques cannot be wiped away [plaques]
  • Acute atrophic candidiasis shows widespread or patchy redness, most often on the palate [atrophy · redness]
  • Denture stomatitis shows redness of the mucosa limited to the area the denture covers [redness]
  • Median rhomboid glossitis is a diamond-shaped red patch on the back-center of the tongue, in front of the circumvallate papillae
  • A mirror-image red patch on the palate opposite a tongue lesion often signals underlying immune suppression
  • Angular cheilitis appears as cracked, red patches at the mouth corners, usually on both sides [redness]
  • Linear gingival erythema is a red line or band along the gum margin of one or more teeth [redness]

Tests (5)

  • Diagnosis is usually made clinically from the lesion's appearance, history, and response to antifungal treatment
  • Biopsy is advised for the atrophic and hyperplastic forms because they can resemble premalignant or malignant lesions
  • Culture and sensitivity testing are used when antifungal treatment does not work
  • When denture stomatitis is suspected, samples are taken from both the denture and the palate, since mucosal sampling alone can miss it
  • An underlying immune-suppressing condition such as HIV, diabetes, or steroid use should also be tested for

If not this — what else fits (4)

  • Thermal burns, erythema migrans, and anemia can mimic the red form of candidiasis, alongside oral mucositis and erythroplakia
  • Chronic hyperplastic candidiasis can be confused with leukoplakia, lichen planus, pemphigoid, pemphigus, or squamous cell carcinoma
  • Oral hairy leukoplakia, an Epstein-Barr virus-driven lesion, is also on the differential
  • Herpes gingivostomatitis and herpes labialis are also on the differential for white or red oral lesions

SourceStatPearls "Oral Candidiasis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Nystatin | Clotrimazole | Oral gel - the option for angular cheilitis and denture stomatitis | Main treatment

NYSTATIN

1

NYSTATIN

Nystatin

1st line

Formoral.liquid

Adult dose and duration

400,000 to 600,000 units 4 times daily; swish in the mouth and retain before swallowing

Paediatric dose

Children and Adolescents: Oral: 400,000 to 600,000 units 4 times daily; administer half of dose to each side of mouth

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023

Why

Topical polyene antifungal that binds fungal membrane sterols; first-line for oral thrush given its minimal systemic absorption.

Cautions
  • Swish around mouth and retain for as long as possible before swallowing.
  • Clean teats/pacifiers and treat mother's nipples if breastfeeding infant.
  • Nystatin has minimal systemic absorption; GI distress is rare.
Egyptian brands
Egyptian brandManufacturerIndicative price
NOCANDIDA 100.000I.U./ML SUSP. 30 MLPHAROPHARMA5.00 EGP
FUNGIFREE 100000 I.U./ML ORAL DROPS 30 MLEUROPEAN EGYPTIAN PHARM. IND.6.00 EGP
MYCOSTATIN 100 000 I.U./ML SUSP. 30MLGLAXO SMITHKLINE > SMITHKLINE BEECHAM8.50 EGP
FUNGISTATIN 100 000I.U./ML 30ML SUSP.DELTA PHARMA9.00 EGP
ORASTATIN 100.000 I.U/ML ORAL SUSP. 30 MLMEPACO > HI-PHARM19.00 EGP
NYSTATIN 100 000 I.U./ML ORAL SUSP. 30 MLEIPICO30.00 EGP

CLOTRIMAZOLE

2

CLOTRIMAZOLE

Clotrimazole

1st line

Formoral.solid

Adult dose and duration

10 mg troche 5 times daily (dissolved over 20 minutes)

Paediatric dose

Dosing for these regimens should be adjusted according to weight for pediatric patients.

Dose source

Oral candidiasis (thrush) - disease-level clinical article (oral-candidiasis-clinical.txt)

Why

First-line topical antifungal troche for mild presentation or first presentation of oral candidiasis.

Cautions
  • Clotrimazole troches are high in sucrose; where there is diabetes or a high risk of dental caries, a once-daily triazole (fluconazole or itraconazole) is the better choice.
Egyptian brands
Egyptian brandManufacturerIndicative price
DERMATIN 1% TOP. POWDER 10 GM? different route - not oral solidPHARCO4.50 EGP
CANEMAZOLE 1% CREAM 20 GM? different route - not oral solidUP PHARMA5.00 EGP
CANDISTAN 1% TOPICAL CREAM 15 GM? different route - not oral solidKAHIRA > ARAB DRUG COMPANY (ADCO)7.25 EGP
DERMATIN 1% TOPICAL SOLN. 20 ML? different route - not oral solidPHARCO10.00 EGP
DERMATIN 1% TOP. CREAM 14 GM? different route - not oral solidPHARCO15.00 EGP
LOCASTEN 2% VAGINAL CREAM 20 GM? different route - not oral solidALEXANDRIA29.00 EGP
OTIXLVI 1% TOPICAL SPRAY 60 ML? different route - not oral solidEL NILE FACTORY FOR COSMETICS > LA PORTE PHARMA60.00 EGP
OTIXLVI 1% TOPICAL LOTION 15 ML? different route - not oral solidEL NILE FACTORY FOR COSMETICS > LA PORTE PHARMA69.00 EGP
CANDISTAN 1% SOLUTION 20 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)8.25 EGP
LOCASTEN 1% TOP. SOLUTION 20 ML? strength differs? different route - not oral solidALEXANDRIA18.00 EGP

ORAL GEL - THE OPTION FOR ANGULAR CHEILITIS AND DENTURE STOMATITIS

3

MICONAZOLE

Oral gel - the option for angular cheilitis and denture stomatitis

1st line

Formtopical

Adult dose and duration

2.5 ml of the 2% gel four times a day after meals, held in the mouth as long as possible before swallowing - Keep going a week or more beyond the point where the mouth looks clear

Paediatric dose
Dose by age
Infants 4 to 24 months:1.25 ml four times a day after meals, each dose split into small portions and smeared on with a clean finger. Never put it at the back of the throat - it can choke a baby. From 2 years the adult 2.5 ml applies.
Dose source

Daktarin Sugar Free 2% Oral Gel SmPC section 4.2 (eMC product 6597)

Why

A gel is what denture stomatitis and angular cheilitis need - it can be smeared on the fitting surface of the denture and on the angles of the mouth, which a suspension or a troche cannot. Oral gel is also the commonest and cheapest miconazole product on an Egyptian pharmacy shelf.

Cautions
  • Stop it at the first sign of a rash - severe skin reactions including Stevens-Johnson syndrome have been reported with oral gel products.
  • The gel is contraindicated in liver dysfunction, and enough is absorbed to raise the effect of warfarin and of oral sulfonylureas - check the patient's other medicines before prescribing.
  • Do not smear the gel on the nipple to dose a breastfed baby, and do not apply it to the back of an infant's throat.
Egyptian brands
Egyptian brandManufacturerIndicative price
MICONOL 2% CREAM 15 GMMEMPHIS5.00 EGP
DERMOZOL 2% GEL 15 GMPHARCO6.00 EGP
MICO ORAL 2% ORAL GEL 30 GMALFACURE PHARMACEUTICALS6.25 EGP
BUCCAZOLE 2% ORAL GEL 20 GMPHARCO12.00 EGP
MICONAZ 2% ORAL GEL 20 GMMUP23.00 EGP
DAKTARIN 2% CREAM 15 GMMINA PHARM > JANSSEN CILAG28.00 EGP
DAKTARIN 2% ORAL GEL 40 GMJANSSEN CILAG > SOFICOPHARM53.50 EGP
ADCOZOLE 2% TOPICAL CR. 15 GMARAB DRUG COMPANY (ADCO)7.25 EGP

MAIN TREATMENT - choose one

4

FLUCONAZOLE

2nd line

Strength50 mg

Formoral.solid

Adult dose and duration

Loading dose of 200 mg on day 1, then 100 to 200 mg once daily

Paediatric dose

(6 mg/kg on day 1, then 3 mg/kg once daily. The dose halves after day 1 - it is not the same every day. Maximum 100 mg per dose at any age: BNF for Children caps 1 month-11 years at 100 mg, and gives 50-100 mg once daily for 12-17 years.)

Dose by age
1 month to 11 years:6 mg/kg on day 1, then 3 mg/kg once daily. Maximum 100 mg per dose.
12 to 17 years:50 to 100 mg once daily
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (fluconazole monograph)

Why

Triazole antifungal that blocks fungal ergosterol synthesis; used orally for moderate-to-severe thrush or when topical nystatin has failed.

Cautions
  • Fluconazole is an option for moderate-to-severe thrush or topical treatment failure.
  • Caution in hepatic dysfunction.
  • The Egyptian formulary gives this regimen - loading dose of 200 mg on day 1, then 100 to 200 mg once daily - for oropharyngeal candidiasis that is moderate to severe (ENDF Antimicrobial 2023, fluconazole monograph).
  • Fluconazole has multiple drug interactions via CYP2C9 and CYP3A4 inhibition.
Egyptian brands
Egyptian brandManufacturerIndicative price
AMRIFLUCAN 50 MG 7 CAPS.AMRIYA24.00 EGP (3.43/unit)
NAVILUCA 50 MG 21 CAPS.INTERNATIONAL DRUG INDUSTRIES > ROTABIOGEN78.75 EGP (3.75/unit)
FLOCAZOLE 50 MG 7CAPS.SPIMACO > EIMC40.00 EGP (5.71/unit)
TRICONAL 50 MG 7 CAPS.UP PHARMA53.00 EGP (7.57/unit)
DIFLUCAN 50 MG 7 CAPS.PFIZER179.00 EGP (25.57/unit)
DIFLUNAZOLE 25MG/5ML SYRUP 70ML? strength differs? different route - not oral solidCID28.80 EGP
FLUCAZONIL 25MG/5ML SYRUP 70 ML? strength differs? different route - not oral solidEL NILE.28.80 EGP
5

ITRACONAZOLE

3rd line

Strength100 mg

Formoral.solid

Adult dose and duration

200 mg once daily without food - Not stated in the monograph - treat until clinical resolution, then reassess; prolonged courses need specialist advice

Paediatric dose

10 mg/kg/day [child max 200 mg]

(Limited data. Infants, children and adolescents: 5 mg/kg every 12 hours (that is 10 mg/kg/day), usual maximum 200 mg/day. Some infections require up to 400 mg/day, which is a specialist decision.)

Dose by weight
3kg30 mg/day
4kg40 mg/day
5kg50 mg/day
6kg60 mg/day
7kg70 mg/day
8kg80 mg/day
9kg90 mg/day
10kg100 mg/day
11kg110 mg/day
12kg120 mg/day
13kg130 mg/day
14kg140 mg/day
15kg150 mg/day
16kg160 mg/day
17kg170 mg/day
18kg180 mg/day
19kg190 mg/day
20kg200 mg/day
21kg200 mg/day (capped)
22kg200 mg/day (capped)
23kg200 mg/day (capped)
24kg200 mg/day (capped)
25kg200 mg/day (capped)
26kg200 mg/day (capped)
27kg200 mg/day (capped)
28kg200 mg/day (capped)
29kg200 mg/day (capped)
30kg200 mg/day (capped)
31kg200 mg/day (capped)
32kg200 mg/day (capped)
33kg200 mg/day (capped)
34kg200 mg/day (capped)
35kg200 mg/day (capped)
36kg200 mg/day (capped)
37kg200 mg/day (capped)
38kg200 mg/day (capped)
39kg200 mg/day (capped)
40kg200 mg/day (capped)
41kg200 mg/day (capped)
42kg200 mg/day (capped)
43kg200 mg/day (capped)
44kg200 mg/day (capped)
45kg200 mg/day (capped)
46kg200 mg/day (capped)
47kg200 mg/day (capped)
48kg200 mg/day (capped)
49kg200 mg/day (capped)
50kg200 mg/day (capped)
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (itraconazole monograph)

Why

16 live products. The formulary lists oropharyngeal and oesophageal candidiasis as an indication and reserves itraconazole for fluconazole-refractory disease - the option to reach for when nystatin and fluconazole have not worked.

Cautions
  • Reserve for fluconazole-refractory disease - the formulary says so explicitly.
  • The formulary does NOT recommend the capsule for candidiasis; the oral solution is better absorbed. Most Egyptian products are capsules, so absorption is the main reason treatment fails.
  • Capsules need stomach acid and food - do not co-prescribe with a PPI or H2 blocker.
  • Itraconazole is a strong CYP3A4 inhibitor: check statins (simvastatin is contraindicated), DOACs, calcium channel blockers, vardenafil, and ergot derivatives before prescribing.
  • Hepatotoxicity can occur - stop for nausea, anorexia, dark urine or jaundice, and check liver enzymes.
  • Recurrent oral thrush in an adult with no inhaled steroid or denture cause needs an HIV and diabetes check, not a stronger antifungal.
  • Use with caution in patients with risk factors for heart failure.
  • Use with caution in patients with risk factors for heart failure (COPD, renal failure, edematous disorders, ischemic or valvular disease).
Egyptian brands
Egyptian brandManufacturerIndicative price
FUNGITRANAZOLE 100 MG 10 CAPS.DEBEIKY32.00 EGP (3.20/unit)
ITRAFUNGIZOLE 100 MG 12 CAPS.AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.42.00 EGP (3.50/unit)
FUNGITRANAZOLE 100 MG 4 CAPS.DEBEIKY15.60 EGP (3.90/unit)
AROZOLE 100MG 4CAPS.ALFACURE PHARMACEUTICALS19.20 EGP (4.80/unit)
ITRANOX 100 MG 5 CAPS.ADWIA36.00 EGP (7.20/unit)
ITRAFUNGEX 100 MG 4 CAPS.FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > UTOPIA33.00 EGP (8.25/unit)
ITRAPEX 100 MG 4 CAPS.MULTI-APEX38.00 EGP (9.50/unit)
SPORANOX 100MG 4 CAPS.JANSSEN CILAG > SOFICOPHARM42.00 EGP (10.50/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.