Azoles for treating thrush

Examples

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Brand Name	Generic Name
Mycelex	clotrimazole

Brand Name	Generic Name
Diflucan	fluconazole

Brand Name	Generic Name
Sporanox	itraconazole

Brand Name	Generic Name
Nizoral	ketoconazole

Brand Name	Generic Name
Monistat	miconazole

These medications are available in forms that are put directly on the infected area (topical) and forms that are swallowed (oral).

How It Works

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Azoles stop the growth of the yeast that causes thrush. This gives the body's immune system a better chance to destroy the yeast.

Why It Is Used

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These medications may be used for cases of thrush that have not responded to nystatin (a polyene).¹

• Miconazole is used to treat thrush in infants and children. The injected form is used to treat a yeast or other fungal infection that has spread to the blood.
• Ketoconazole is used to treat thrush in children, and it is the preferred antifungal medication for use in people who have a weakened immune system. Ketoconazole and fluconazole can cure thrush that has spread into the esophagus.

How Well It Works

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Azoles are effective in curing thrush, especially when other topical treatment has not been helpful.²

Ketoconazole and fluconazole can cure thrush that has spread into the esophagus.

Side Effects

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Although azoles rarely cause side effects, they may cause:

• Nausea, vomiting, and abdominal pain.
• Headache.
• Itching, skin rash.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Although azoles have been shown to be safe for babies and children in a few limited studies, more research is needed.³ Usually polyenes are tried first. Azoles are usually tried after polyenes have failed to cure the infection.

It is hard for some people to use a nystatin mouthwash because of its taste. In these cases, clotrimazole lozenges may be given instead.¹ But there is a slight possibility that taking clotrimazole can cause liver problems. Because of this, it is rarely given to children.

Certain medicines can interact with azoles. This can make the azole less effective or can cause problems with the liver. Some of these medicines include:

• Some ulcer medications (sucralfate and H2 receptor antagonists).
• A seizure medication called phenytoin (Dilantin).
• A tuberculosis medication (rifampin).
• A medication used to prevent rejection in organ transplants (cyclosporine).
• Allergy medications called terfenadine and astemizole (Hismanal).
• A blood thinner called warfarin sodium (Coumadin).

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Weinberg A, Levin MJ (2007). Candidiasis section of Infections: parasitic and mycotic. In WW Hay Jr et al., eds., Current Pediatric Diagnosis and Treatment, 18th ed., pp. 1240–1243. New York: McGraw-Hill.

2. Fox CR, Sande MA (2001). Candida species. In WR Wilson et al., eds., Current Diagnosis and Treatment in Infectious Diseases, pp. 734–744. New York: McGraw-Hill.

3. American Academy of Pediatrics (2006). Candidiasis (moniliasis, thrush). In LK Pickering et al., eds., Red Book: 2006 Report of the Committee on Infectious Diseases, 27th ed., pp. 242–246. Elk Grove Village, IL: American Academy of Pediatrics.

Credits

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Author	Maria G. Essig, MS, ELS
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer	Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics
Last Updated	March 10, 2008