Prescription instructions: Antifungals

These prescriptions are provided as a baseline as recommended by professional guidelines and standard texts, intended for use by average sized middle-aged adults with no significant medical history, risk factors or concomitant medications. Clinicians are reminded that such prescriptions may not be appropriate for all adult patients, and as such, should always be tailored to individual patient circumstances, accounting for variations in age, weight, co-morbidities, risk factors and concomitant medication.  For individual advice, send a query to our Pharmacy expert, Dr Geraldine Moses.

Source: Therapeutic Guidelines Oral and Dental v3. 2019

Miconazole

Rx Miconazole 2% oral gel 15g
ADULTS & CHILDREN: >2 yrs: Apply ½ measuring spoonful onto the affected area, 4 times a day after food or drink for 7-14 days as guided by symptom resolution.

CHILDREN: <2yrs: Apply ¼ teaspoon, 4 times a day after food or drink for 7-14 days as guided by symptom resolution.  

INFANTS: The gel should be applied at the front of the mouth to prevent choking.

Considerations:

  • Miconazole is a strong inhibitor of liver metabolism via CYP2C9. Can increase levels of other drugs metabolised by 2C9 such as warfarin, phenytoin, ibuprofen, meloxicam.

  • Miconazole is not on the PBS for dentists. However, it may be purchased without prescription from a pharmacist (S3- Pharmacist only medicine)

Nystatin

Rx Nystatin 100,000 units/mL oral suspension 24ml
Shake well before use.

Drop 1mL of liquid onto the affected area in the mouth, 4 times a day, after food or drink meal. Hold liquid in the mouth for as long as possible, then swallow.  Use for 7-14 days as guided by symptom resolution.

Considerations:

  • Nystatin is not absorbed systemically, so carries little risk of side effects or drug interactions. It is therefore safe to use in pregnancy and breastfeeding.

  • DO not use in infants, as the administration technique is too difficult. Liquid contains ~50% sucrose, so may predispose to caries.

  • Nystatin is on the PBS for dentists. However it is also available for purchase without prescription from a pharmacist (S3- Pharmacist only medicine)

Amphotericin

Rx Amphotericin 10mg lozenges
1x lozenge to be sucked then swallowed, FOUR times daily after food or drink.  Use for 7-14 days and guided by symptom resolution.

Considerations:

  • Amphotericin is not absorbed systemically, so carries little risk of side effects or drug interactions. It is therefore safe to use in pregnancy and breastfeeding.

Fluconazole

Considerations:

  • Systemic antifungal therapy is recommended for adults with severe oropharyngeal candidiasis (eg multiple or confluent lesions, swallowing difficulties), or oral and oropharyngeal candidiasis that does not respond to topical antifungal therapy.

  • Due to the high potential risk of adverse effects and drug interactions, it is recommended dentists DO NOT PRESCRIBE fluconazole, but refer the patient to an oral medicine specialist or their doctor for this. 

PBS = Pharmaceutical Benefits Scheme.

Refs:

1)         Oral and Dental Expert Group. Therapeutic Guidelines: Oral and Dental. Version 3. Melbourne