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Best treatment for thrush

Jan 26, 1997

I just moved to a new city and had to change doctors. My old doctor had me on Diflucan because I'd had oral thrush several times. My new doc wants to take me off and make me suck on those lozenges all the time. I don't see why I have to change-- the Diflucan was easier and it worked great. My CD4 count is in the 90's. Thanks.

Response from Dr. Cohen

Sorry, but I have to agree with your new doctor. I'll admit that fluconazole (Diflucan) is a very convenient and effective drug for treating thrush. But it's a little like trying to put out candle with a fire extinguisher. You're treating a mild local infection with a powerful, expensive, systemically absorbed drug that is not without side effects and drug interactions.

More important is the fact that extensive or early use of fluconazole probably puts you at risk for developing fluconazole-resistant Candida infections down the road. Those can be very difficult to treat, sometimes requiring life-long amphotericin B. Amphotericin is not an easy drug to take, and it has to be given intravenously through a permanent IV catheter.

Fluconazole is too important of a drug to use when you don't really need it. If your CD4 count gets lower, you may have to take it for Candida esophagitis or cryptococcal meningitis, and then you really NEED it to work.

Mycelex troche (the lozenges) or nystatin or amphotericin oral solution may be more inconvenient and may not work quite as fast, but they do work. By using them for mild conditions like thrush you save the big guns for more serious infections.

OK to stop pentamidine?
Do I really have to do-in Daphne?

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