Candidiasis Drug Summary

Last updated: 03 March 2026
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Antifungals

Drug Dosage Remarks
Allylamine
Terbinafine Cutaneous:
250 mg PO 24 hourly x 2-4 weeks

 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal pain, loss or disturbance of taste, liver dysfunction); Dermatologic effects (rash, urticaria); Other effect (headache)
Special Instructions
  • Do not use in patients with hepatic impairment
  • Perform liver function tests (LFTs) in all patients before starting oral therapy
  • Use with caution in patients with psoriasis
  • Reduce doses in patients with renal impairment
Onychomycosis:
250 mg PO 24 hourly x 6-12 weeks
Echinocandins
Anidulafungin Oropharyngeal (severe/refractory disease):
Loading dose: 200 mg IV on day 1
Followed by: 100 mg/day IV x 7-14 days after clinical improvement

 Adverse Reactions
  • GI effects (nausea/vomiting, increased LFTs); Dermatologic effects (rash, facial swelling, pruritus, sensation of warmth); Other effects (flushing, headache, fever, venous complications around infusion site)
Special Instructions
  • Not to be administered as bolus injection
  • Discontinue use if anaphylactic reactions occur
  • Monitor LFTs during therapy and in patients who develop abnormal LFTs
Esophageal:
Loading dose: 100 mg IV on day 1
Followed by: 50 mg/day IV x 14-21 days after clinical improvement 
Caspofungin Oropharyngeal (severe/refractory disease):
50 mg slow IV infusion over 1 hour 24 hourly

 Adverse Reactions
  • GI effects (nausea/vomiting, increased LFTs); Dermatologic effects (rash, pruritus, sensation of warmth); Other effects (facial swelling, flushing, headache, fever, venous complications around infusion site)
Special Instructions
  • May need to reduce doses in patients with hepatic impairment
Esophageal:
50 mg slow IV infusion over 1 hour 24 hourly x 7-14 days
Micafungin Oropharyngeal (severe/refractory disease):
100 mg/day IV x 7-14 days after clinical improvement
 Adverse Reactions
  • GI effects (nausea/vomiting, increased LFTs); Dermatologic effects (rash, facial swelling, pruritus, sensation of warmth); Other effects (flushing, headache, fever, venous complications around infusion site)
Special Instructions
  • Use with caution in patients with renal or hepatic impairment
  • Monitor renal and hepatic function in patients with renal or hepatic impairment
Esophageal (severe/refractory disease):
150 mg/day IV x 14-21 days after clinical improvement 
Imidazoles
Clotrimazole Oropharyngeal:
10 mg troche or lozenge 4-5x/day x 7-14 days after clinical improvement		 Adverse Reactions
  • GI effects (increased liver enzymes, GI disturbance); Other effects (dysuria, mental depression)
Ketoconazole Chronic mucocutaneous:
200-400 mg PO 24 hourly
Continue treatment until active fungal infection has resolved		 Adverse Reactions
  • GI effects (nausea/vomiting, abdominal pain, serious hepatotoxicity); Dermatologic effects (urticaria, angioedema, pruritus, rash, alopecia); CNS effects (headache, dizziness, somnolence); Other effects (inhibition of testosterone and adrenal steroid synthesis [high dose], rarely gynecomastia)
Special Instructions
  • Use only to treat serious fungal infection when other therapies are not tolerated or unavailable
    • Carefully consider the benefits against potential risks of therapy
  • Contraindicated in patients with acute or chronic liver disease
  • Monitor LFTs at baseline and weekly during treatment course
  • Use with caution in patients with adrenal insufficiency
Other Antimycotic for Systemic Use
Ibrexafungerp Vulvovaginal:
Uncomplicated:
300 mg PO 12 hourly
Recurrent:
300 mg PO 12 hourly for 1 day monthly x 6 months		 Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, abdominal pain); CNS effects (headache, dizziness); Other effects (urinary tract infection, fatigue)
Special Instructions
  • Doses to be taken in the morning and in the evening approximately 12 hours apart
  • May be taken with or without food
Polyenes
Amphotericin B deoxycholate Oropharyngeal:
Refractory: 0.3 mg/kg IV 24 hourly
Itraconazole-resistant cases: 1 mL of 100 mg/mL suspension PO 6 hourly x 7-14 days after clinical improvement

 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal cramps, anorexia, GI bleeding, liver disorders); CV effects (hypertension, hypotension, arrhythmias); Dermatologic effects (rashes, flushing, anaphylactoid reactions); Metabolic effects (hypokalemia, hypomagnesemia); Hematologic effects (anemia, thrombophlebitis at injection site); Other effects (blurring of vision, tinnitus, hearing loss, headache, fever, chills, muscle and joint pain, malaise, pain at injection site)
  • Nephrotoxicity occurs in almost all patients
Special Instructions
  • Although anaphylaxis is rare, it is advisable to administer a test dose and observe the patient before starting treatment
  • To reduce febrile reactions, antipyretics and antihistamines may be given prior to AmB dose
  • Monitor patient for changes in liver function, renal function, serum electrolytes and hematologic status
    • If blood urea nitrogen (BUN) and creatinine (Cr) levels rise, decrease the dose of AmB or change to lipid formulation
  • Infuse drug slowly to avoid vein irritation and infusion-related adverse effects
  • Care should be taken not to confuse the dosage regimens for individual preparations
Esophageal (severe/refractory cases):
0.3-0.7 mg/kg/day IV x 14-21 days after clinical improvement
Nystatin Oropharyngeal:
1 mL of 100,000 U/mL oral suspension retained in the mouth as long as possible 6 hourly
Higher doses may be used in immunocompromised patients
Duration: 7-14 days; patient should be treated x 48 hours more after improvement
As prophylaxis:
1 mL of 100,000 U/mL oral suspension 24 hourly
Continue dosage regimen for at least 48 hours after symptoms have disappeared		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, oral irritation); Dermatologic effects (rashes and urticaria have been reported)
Special Instructions
  • Should not be used for treating systemic mycoses
  • Discontinue if irritation and sensitization occurs
Triazoles
Fluconazole Oropharyngeal:
200-400 mg PO on day 1 then 100-200 mg PO 24 hourly x 7-14 days
Recurrent infection: 100 mg PO 3x/week
 Adverse Reactions
  • GI effects (abdominal pain, diarrhea, flatulence, nausea/vomiting, taste disturbance, elevated liver enzymes)
Special Instruction
  • Use with caution in patients with renal and hepatic impairment
Esophageal:
50-100 mg PO 24 hourly x 14-30 days or
200 mg PO 24 hourly x 1 day then 100 mg PO 24 hourly x 21 days
or
Patient who cannot tolerate oral therapy:
400 mg IV 24 hourly
For recurrent esophagitis, chronic suppressive therapy:
100-200 mg PO 3x/week 
Chronic mucocutaneous:
50-100 mg PO 24 hourly x 14-30 days
Duration should be based on clinical and mycological response 
Vulvovaginitis:
Uncomplicated: 150 mg PO single dose
Severe, acute: 150 mg PO 72 hourly
Recurrent: Induction therapy for 10-14 days PO followed by 150 mg PO weekly x 4-12 months
Onychomycosis: 200 mg PO 12 hourly x 1 week, repeat monthly x 2-3 months (pulse therapy)
Itraconazole Adverse Reactions
  • GI effects (dyspepsia, abdominal pain, nausea, constipation, diarrhea, increased liver enzymes, hepatitis, cholestatic jaundice); CNS effects (headache; dizziness); Dermatologic effects (pruritus, rash, urticaria, angioedema); Other effects (alopecia, edema, hypokalemia with prolonged treatment)
Special Instructions
  • Use with caution in patients at risk for hepatic failure, hepatic impairment and renal insufficiency
  • In patients with hypochlorhydria, absorption may be improved by administering the drug with an acidic drink (eg cola)
Oropharyngeal (including Fluconazole-resistant cases):
Capsule: 100-200 mg PO 24 hourly x 15 days
Oral solution: 200 mg PO 24 hourly or divided 12 hourly x 2-3 weeks
Esophageal:
Oral solution: 100-200 mg PO 12 hourly x 2-3 weeks 
Chronic mucocutaneous: 100-200 mg PO 24 hourly
Vulvovaginitis: 200 mg PO 12 hourly x 1 day or 200 mg PO 24 hourly x 3 days 
Oteseconazole Recurrent vulvovaginal:
Monotherapy:
Day 1: 600 mg PO
Day 2: 450 mg PO
Day 14: 150 mg PO weekly x 11 weeks
Combination with Fluconazole:
Day 14-20: 150 mg PO 24 hourly x 7 days
Day 28: 150 mg PO weekly x 11 weeks		 Adverse Reactions
  • GI effect (nausea); CNS effect (headache)
Special Instructions
  • Contraindicated in patients with severe renal impairment, end-stage renal disease, moderate or severe hepatic impairment, females of reproductive potential, and in pregnant and lactating women
Posaconazole Oropharyngeal:
400 mg PO 12 hourly x 3 days then 400 mg PO 24 hourly up to 28 days or
200 mg PO 24 hourly loading dose on the first day followed by 100 mg PO 24 hourly x 13 days
Refractory oropharyngeal: 400 mg PO 12 hourly or 200 mg PO 6 hourly with limited oral intake
 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal pain, dyspepsia, anorexia, flatulence, dry mouth); CNS effects (headache, dizziness, insomnia, somnolence, paresthesia); Other effects (back pain, dry skin, fatigue, fever)
Special Instructions
  • Use with caution in patients at risk for cardiac arrhythmia
  • Monitor hepatic function
Esophageal (Fluconazole-refractory disease): 400 mg PO 12 hourly x 14-21 days
or
Extended-release: 300 mg PO 24 hourly 
Voriconazole Esophageal:
Patient ≥40 kg:
Loading dose: 400 mg PO 12 hourly x 1 day followed by
Maintenance dose: 200 mg PO 12 hourly
Patient <40 kg:
Loading dose: 200 mg PO 12 hourly x 1 day followed by
Maintenance dose: 100 mg PO 12 hourly x minimum 14 days and at least 7 days after symptoms resolve		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal pain); Other effects (visual disturbances, fever, rashes, headache, peripheral edema)
Special Instructions
  • Use with caution in patients with hepatic impairment
  • For patients affected by visual disturbances, driving or operating machinery should be avoided
  • Avoid sunlight during treatment as photosensitivity reactions have been reported

Antifungals (Topical)

Drug Available Strength1 Dosage Remarks
Allylamines
Naftifine 1% cream Apply 24 hourly Adverse Reactions
  • Dermatologic effects (redness, stinging, itching)
Special Instructions
  • Duration of therapy: 2-4 weeks
Povidone-iodine 1% solution, cream, spray Apply 12-24 hourly
Terbinafine 1% cream Apply 12-24 hourly
Imidazoles
Bifonazole 1% cream Apply 24 hourly Adverse Reactions
  • Dermatologic effects (occasional local irritation and hypersensitivity reactions, mild burning, erythema, pruritus)
Special Instructions
  • Duration of therapy: 2-4 weeks
  • Avoid contact with eyes
Clotrimazole2 1% powder, solution, lotion, cream, spray Apply 8-12 hourly
Econazole2 1% cream Apply 12-24 hourly
Fenticonazole 2% cream, spray Apply 12-24 hourly
Isoconazole 1% cream Apply 12-24 hourly
Ketoconazole 2% gel, cream, solution Apply 12-24 hourly
Luliconazole 1% cream; 5% solution Apply 24 hourly
Miconazole2 2% powder, solution, cream, gel Apply 12 hourly
Sertaconazole 2% cream Apply 12-24 hourly
Tioconazole 1% cream, lotion Apply 12-24 hourly
Polyene
Nystatin2 100,000 u/g cream Apply 6-24 hourly for 14 days Adverse Reactions
  • Local irritation is rare
Special Instructions
  • Duration of therapy: 2-4 weeks
Others
Amorolfine 0.25% cream; 5% nail lacquer Cream: Apply 24 hourly in the evening
Nail lacquer: Apply once or twice weekly		 Adverse Reactions
  • Slight transient burning sensation
Special Instructions
  • Duration of therapy: 2-4 weeks
Ciclopirox
(Ciclopiroxolamine, Ciclopirox olamine)		 1% cream; 8% nail lacquer Cream: Apply 12 hourly
Nail lacquer: Apply every other day for first month; reduce to not less than 2x weekly in second month, and once weekly from third month onwards		 Adverse Reactions
  • Pruritus, redness, burning, pain
Special Instructions
  • Duration of therapy: 2-4 weeks
1For vaginal preparations used for the treatment of vulvovaginal candidiasis, please see Vaginitis: Trichomoniasis, Candidiasis, Bacterial Vaginosis disease management chart for further information.
2Various combination preparations are available. Please see the latest MIMS for specific formulations and prescribing information.

Oropharyngeal Anti-infectives

Drug Available Strength Dosage Remarks
Miconazole 0.2% oral gel Infants 6-24 months old: Apply 1.25 mL to affected area 6 hourly
Adults and children >2 years old: Apply 2.5 mL to affected area 6 hourly		 Adverse Reactions
  • GI effects (nausea/vomiting with long-term treatment, diarrhea)
Special Instructions
  • Should not be swallowed immediately, but kept in the mouth as long as possible
  • Should not be applied at the back of the throat and full dose should be divided in smaller parts especially in infants and young children
  • Continue for at least a week after resolution of symptoms
  • Remove dental prostheses at night and brush using the gel
  • Contraindicated in patients with liver dysfunction

Preparations for Oral Ulceration & Inflammation

Drug Available Strength Dosage Remarks
Chlorhexidine gluconate 0.12%, 0.2% mouthwash Oral: Rinse mouth with 10-30 mL for 1 minute 12 hourly
Continue treatment for 48 hours after clinical resolution		 Adverse Reactions
  • GI effects (taste alteration, oral desquamation, transient parotitis, burning sensation of the tongue on initial use)
Special Instructions
  • Avoid in patients with hypersensitivity
Clotrimazole Lozenge Oropharyngeal:
10 mg lozenge 4-5x/day x 7-14 days after clinical improvement		 Adverse Reactions
  • GI effects (taste alteration, oral desquamation, transient parotitis, burning sensation of the tongue on initial use)
Special Instructions
  • Avoid in patients with hypersensitivity
Hexetidine 0.1% oral solution Oral: Rinse mouth or gargle for 30 seconds with 10-20 mL of undiluted solution or apply using a cotton wool swab for 2-3 minutes
Duration: Not to exceed 8 hourly		 Special Instructions
  • Do not swallow
  • Long-term use is not recommended; do not use for >10 days

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

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