Azoles for treating thrush

Examples

Generic Name	Brand Name
clotrimazole	Mycelex
fluconazole	Diflucan
itraconazole	Sporanox
ketoconazole	Nizoral
miconazole	Monistat

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

How It Works

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

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

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

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

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).

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Author:	Maria G. Essig, MS, ELS	Last Updated: March 10, 2008
Medical Review:	Michael J. Sexton, MD - Pediatrics Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics
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