10 best remedies for thrush (candidiasis)

*Overview of the best according to the editors of Healthy Food Near Me. About selection criteria. This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.

Thrush, or candidiasis, is the most harmless of mycoses, or fungal infections. “The most harmless” with one caveat: this is so if candidiasis, or thrush, affects a limited area of ​​uXNUMXbuXNUMXbthe mucous membrane, directly bordering on the external environment. And in this case we are talking about two options: thrush in the oral cavity (for example, in a baby) and thrush in the vagina in women. Both in the first and in the second case, we are talking about a fairly frequent contact of the mucous membrane with the outside world. But this should not be interpreted literally, that a woman must have a large number of sexual partners, and the baby must constantly pull everything into her mouth in order for thrush to occur. It’s just that nature is so arranged that the deeper mucous membranes, for example, the mucous membrane of the ureters or the esophagus, are much better protected. And if candidiasis appears already there, then we are talking about a systemic lesion, and this is due to a decrease in immunity.

Most often, systemic candidiasis develops in patients who have HIV infection in the AIDS stage, in people with long-term use of immunosuppressants or cytostatics, steroid hormones. For example, a patient who is undergoing pulse therapy with methylprednisolone in an amount of 1 g daily for an exacerbation of multiple sclerosis has a high risk of fungal infection of the esophagus due to a sharp decrease in immunity. But we will not analyze such extreme cases, but we will simply adhere to the opinion that fungi of the genus Candida (and most often, the albicans species) are opportunistic flora, and it is constantly present in a healthy person in the intestinal lumen, oral cavity, on mucosa of the genital organs, and does not cause any diseases with healthy immunity. But when the fungi begin to multiply intensively, this fact is a serious signal of reduced immunity, leading to the appearance of a manifest fungal infection.

That is why candidiasis, or thrush, is called an opportunistic infection by specialists. Its activation signals a decrease in immunity, not only local, but also general. Therefore, people suffering from thrush quite often also have comorbidities: these are diabetes mellitus, oncological diseases that are fought with radiation and chemotherapy, and other conditions.

Classical thrush, or candidiasis, is called by a bright clinical picture: usually the mucous membrane is hyperemic, has a bright red color. Against this background, whitish spots can be found, sometimes having a bluish tint, resembling loose cottage cheese or spilled milk, but most often these spots resemble kefir. If you rub such a speck in your fingers, which can be carefully removed, for example, from the mucous membrane of the baby’s oral cavity, and smell it, you can determine the weak, but distinct aroma of the fungus. What are the risk factors and symptoms of thrush that allow opportunistic fungi to become the causative agent of the disease, oral and vaginal candidiasis?

Symptoms of thrush of different localizations

Symptoms of banal candidiasis are the presence of a curdled, easily removable plaque on an unchanged mucous membrane. The patient may note past infectious diseases as factors for reducing immunity, taking antibiotics, immunosuppressive drugs, in women – taking oral contraceptives, leading to a decrease in the overall resistance of the body.

1. In the case of vaginal candidiasis, or moderate thrush, there is discomfort, pain and burning during intercourse, and in the case of oral candidiasis (oral cavity) – when eating. In this case, the cheesy plaque is already difficult to remove, and after removal, a bright, hyperemic mucosa is exposed.

2. In the case of a severe form of candidiasis, the fungal plaque begins to adhere tightly to the underlying mucosa. If it is removed, then bleeding erosions are already detected, against this background, a general malaise often occurs, and the temperature rises to 38 degrees.

3. In some cases, severe candidiasis turns into an acute atrophic process, which is accompanied by dry mucous membranes, burning, and discomfort. Such atrophic candidiasis is quite common in the oral cavity of the elderly, and especially in the presence of poor-quality, or ill-fitting dentures, which are not properly cared for. Sometimes such chronic atrophic candidiasis is accompanied by cracks in the corners of the mouth, a perversion of taste, and a change in the color of the fungal plaque from bluish-white to gray.

What are the features of vaginal candidiasis, that is, a fungal infection of the mucous membrane of the external genital tract in women? These are the same cheesy, thick vaginal discharge, which are accompanied by hyperemia and swelling of the mucous membranes. There may be cracks and hyperemia in the posterior and lateral fornix of the vagina, in the region of the posterior commissure. If there is a recurrent process, then the discharge becomes scarce, there is a pronounced dryness and atrophy of the mucosa. In women, symptoms in the form of burning and discomfort usually increase before menstruation. During sexual intercourse, intense discomfort, soreness and discomfort occur. When urinating, burning, soreness and itching in the urethra are also possible.

This process also occurs in men, called candidal balanitis and balanoposthitis. This is swelling and hyperemia of the head of the penis, similar rashes in the form of spots or erosions on the head, white plaque appears, cracks, the lips of the urethra become hyperemic, discharge of the same curdled nature can be periodically detected from the urethra.

thrush Treatment

This review includes the 10 most popular and effective drugs for the treatment of oral and vaginal candidiasis. Almost all of these drugs are available either in the form of suppositories, for topical use, or in the form of tablets or capsules. In some cases, it can be a cream, ointment, or even just a special liquid for applications and lubrication of the mucosa.

If we are talking about the treatment of female vaginal candidiasis, then the best way to local therapy are vaginal suppositories, or suppositories. They help treat deep-lying foci of infection, the upper vagina, and even spread the medicinal substance to the cervix, the orifices of the fallopian tubes, and even the tubes themselves, although thrush rarely affects such deep sections of the internal genital organs. But even in this case, candles are more effective than ointment or cream, which are more intended for external localizations of the fungus.

Quite often, suppositories can contain several therapeutic factors that are combined, for example, an antifungal drug along with an antibiotic. In some cases, it is possible to replace the fat-soluble suppository base with another base, and the result is vaginal tablets. The advantages of suppositories used to treat vaginal candidiasis include speed of action: they begin to melt already at 36 degrees, since their base is a mixture of paraffin with gelatin and glycerin. Within one or two minutes, the drug is evenly distributed over the mucosa, begins to act on the circulatory network of the small pelvis, and due to the well-developed vaginal capillary network, part of the active substances enters the bloodstream. But, unlike swallowed tablets, the medicine in the form of suppositories does not pass through the microsomal system of the liver, which makes it possible to manage with lower concentrations with a greater effect.

This drug review includes various tablets, creams, ointments, vaginal capsules, which are highly effective and can be used both singly, that is, as monotherapy, and as a combination.

At the beginning, an international non-proprietary name, i.e. INN, is given for each drug. Then – a list of trade names of the medicine, and the most expensive, that is, the original drug, usually comes first. The original drug is usually created first, but it has the largest number of studies on efficacy and safety. The original drug is made from the purest chemical substance, and all other manufacturers of commercial copies, or generics, are equal to it. That is why the original drug is more expensive, but it can be considered the standard of effectiveness for this drug.

The price range is also given, which is relevant for the beginning of the summer of 2020 for pharmacies of all forms of ownership in the territory of the Russian Federation. All drugs listed in the list are recommended by modern algorithms for the treatment of oral and vaginal candidiasis, treatment protocols, as well as national Russian and international clinical guidelines.

The listing of these drugs is not an advertisement and an invitation to purchase, and the appointment of antifungal agents and the treatment of any type of candidiasis is the prerogative of the attending physician. Only he should prescribe certain drugs, taking into account indications and contraindications.

This review is for informational purposes only in order to acquaint the patient, or simply any person interested in the problem of treating thrush, with the range of modern medicines. And we will start the list with, perhaps, the most famous and effective medicine, namely, fluconazole.

Rating of the best remedies for thrush (candidiasis)

Fluconazole (Diflucan, Diflazon, Mikomax, Mikosist, Fangiflu, Flukonorm, Flukostat, Ciscan)

Rating: 4.9

One of the best fluconazole drugs can be considered Diflucan. It is very popular, and has many generic and commercial copies. For the treatment of oral candidiasis, it is necessary to take 50-100 mg per day of medication for 1-2 weeks, together with local treatment. Locally, you can rinse your mouth with a slightly pink solution of potassium permanganate, a solution of nystatin, or even ordinary drinking soda.

As for the treatment of vaginal candidiasis, it is necessary to use Diflucan in tablets of 150 mg once, together with the same medicine in the form of suppositories. Candles containing 150 mg of fluconazole in the amount of 4 pieces can be purchased in a very different price range: 90 rubles. you will give for domestic suppositories with fluconazole, and the original drug Diflucan from Pfizer will cost you from 730 to 1500 rubles. for four candles.

Advantages and disadvantages

The advantage of Diflucan and its analogues can be considered high efficiency, the ability to take it with a variety of types of mycoses, for example, with dermatophytosis, epidermophytosis, with severe forms of candidiasis, for example, candidiasis of the lungs, candidal sepsis and even candidal endocarditis. But the drug must be taken taking into account contraindications: it should not be taken with drugs that increase the QT interval on the cardiogram, for example, with erythromycin and quinidine. With caution, fluconazole should be prescribed in case of pathology of the liver, kidneys, as well as with the simultaneous use of terfenadine, as well as if the patient has a tendency to various arrhythmias.

Ketoconazole (Livarol)

Rating: 4.8

Livarol is a domestic ketoconazole, which is produced by Nizhpharm. Livarol is usually available in the form of vaginal suppositories, 400 mg each, in a package of 10 pieces. You can buy such packaging at prices from 660 to 930 rubles. Livarol with vaginal candidiasis is used one suppository per day for 3-5 days, and in the case of a chronic course, one suppository for 10 days. Even with improvement, you cannot interrupt the course of treatment yourself, since such intermittent treatment can lead to the transformation of candidiasis into a chronic form. Ketoconazole can also be found in tablets of 200 mg. It can be taken 1-2 tablets per day for 2 weeks, and then 1 tablet per day until the candidiasis of the oral cavity disappears completely.

Advantages and disadvantages

The relative shortage of ketoconazole tablets can be considered a disadvantage, since most often it is sold either in suppositories or in the form of a shampoo, in case of a fungal infection of the scalp, in case of dandruff. On the other hand, there are contraindications, even for topical application. These include severe liver and kidney damage, pregnancy, and breastfeeding. However, ketoconazole in suppositories is not used so often, and therefore, fungi rarely develop resistance to it, and this must be taken into account.

Clotrimazole (Candide)

Rating: 4.7

Clotrimazole, or Candide, is available in a wide variety of forms, in tablets, suppositories, in the form of ointments and creams, and even as a liquid for application to mucous membranes. Almost all varieties of the drug are produced by the Indian company Glenmark. So, one dropper bottle with a volume of 15 ml, 1% solution, can be purchased at prices from 300 to 370 rubles. for a bottle. It is used for applications on the affected areas of the oral mucosa once a day for 1-2 weeks. In the case of vaginal tablets, (most often we are dealing with a 500 mg tablet with an applicator). They must be inserted deep into the vagina. One such tablet will cost from 60 to 85 rubles. per pack of one tablet. Such vaginal tablets are sold, however, under a slightly different name: Candide B6. They must be administered one tablet 1 time per day in the evening.

Advantages and disadvantages

The advantages of clotrimazole are its wide distribution in various pharmacy chains, low price, good quality, rare occurrence of side effects in the form of a slight burning sensation, but this is immediately after the introduction of a tablet or liquid application. The burning sensation passes very quickly. Only hypersensitivity to clotrimazole can be considered a contraindication. Such good qualities have a downside: the widespread use of this drug is gradually causing resistance to it in many fungi, including Candida albicans. Therefore, it is necessary to combine oral antifungal therapy with topical application of clotrimazole.

Natamycin (Pimafucin)

Rating: 4.6

Natamycin is sold as a cream, vaginal suppositories, and enteric tablets. The most commonly used vaginal suppositories are 100 mg. A package of 6 pieces will cost from 410 to 480 rubles, made in Italy. Pimafucin can be considered a second-line antifungal drug. Natamycin is often used if there is vaginal or oral candidiasis, but the fungi are not representatives of the albicans species, although they are representatives of the Candida genus. In other words, natamycin is best used after the analysis from the mycological office has already arrived, and it has been revealed that candidiasis caused by another species is taking place.

It is necessary to be treated with pimafucin in the development of vaginitis, vulvovaginitis of candidal etiology. The drug in tablets can be used for intestinal candidiasis, as well as for severe forms of candidiasis and after antibiotic therapy, corticosteroid hormones and cytostatics. The medicine is administered intravaginally by one suppository. The candle is inserted deep inside, in the supine position once a night. The course of treatment is from 3 to 6 days. In the case of a persistent course of the disease, Pimafucin is additionally prescribed in tablets, one tablet four times a day for 2-3 weeks. This event is necessary in order to sanitize the focus of a possible candidal infection in the intestine. Additionally, you can prescribe Pimafucin in the form of a cream to treat candidal lesions of the genital organs in a partner, if any. In this case, the duration of the course is individual, but after the disappearance of the symptoms of the disease, it is recommended to continue treatment for a few more days.

Advantages and disadvantages

Natamycin is very well tolerated, and in the case of suppositories no special precautions are required, and in the case of tablets they are contraindicated only in people with rare congenital intolerance to galactose and fructose. The drug is effective, unlike clotrimazole, is not used so often, and resistance to them in Candida fungi develops slowly.

Itraconazole (Orungal)

Rating: 4.6

Orungal, or itraconazole, is considered one of the most expensive antifungal drugs. A package of 14 capsules will cost from 2800 to 3900 rubles, Orungal is produced by Janssen Cilag, a division in Italy. You can also find cheaper medicines, and the cheapest, perhaps, will be itraconazole, which will cost for the same package, starting from 330 rubles. Naturally, this is a domestic company ABBA Rus. Use of itraconazole for vaginal candidiasis is necessary in these vaginal tablets, once a day at bedtime for 10 days, in case of acute candidiasis. In case of oral candidiasis, 1 tablet is used once a day for 1 days. This medicine has a high level of evidence, and its high cost is due to a special production technology. And we must not forget that for Europe this is a low cost: the Russians simply receive little. At the same time, Orungal is used for serious diseases, such as histoplasmosis, aspergillosis, which are practically not cured by anything else.

Advantages and disadvantages

As happens quite often, the disadvantages are a continuation of the advantages. This means that the high efficiency of this remedy and the high price indicate that Orungal is quite difficult to find in pharmacies, it is only in big cities. The second is a rather rare appointment of Orungal and its analogues for banal candidiasis. Doctors reserve this drug for severe forms of fungal diseases, so that it is prescribed as rarely as possible, and resistance does not develop to it, and this is completely justified.

Butoconazole (Ginofort)

Rating: 4.5

This is a vaginal cream that contains 2% butaconnasnol. The cream is available in special cases, 5 pieces in one case. It is necessary to use one pencil case once a day once before going to bed. This medicine is produced by the Hungarian company Gedeon Richter, and five doses can be bought at a price of 600 to 850 rubles. Gynofort is a cream with a high adhesive property, and was created specifically for the treatment of vaginal candidiasis. The cream is injected with a single application of the contents of 1 applicator, which must be administered according to the instructions, slowly pressing on the piston, the cream should be squeezed out of the applicator.

Advantages and disadvantages

The drug is well tolerated, and it has practically no side effects, however, the drug may be contraindicated in pregnant women, lactating women, as well as children and girls under the age of eighteen. It is especially necessary to remember that the cream contains mineral oil, which can damage rubber and latex, including condoms. Therefore, within 3 days after the use of the drug, you should not use the appropriate contraceptive.

Tinidazole+thioconazole (Gynomax)

Rating: 4.5

Gynomax for the treatment of vaginal candidiasis is prescribed relatively infrequently. This is a Turkish high-quality antifungal agent, and a package of 7 vaginal suppositories will cost a lot: from 900 to 1300 rubles. Gynomax contains two components. Therefore, as a result, these suppositories act on fungi, and on protozoa, and on anaerobic bacteria. The drug is indicated for chronic vaginitis, not only candidal, but also for trichomoniasis and gardnerellosis. And this means that with this remedy it is good to treat a fungal infection of the vagina that has arisen against the background of bacterial vaginosis. The drug is administered once at night for a week. There is also an alternative scheme that a gynecologist can introduce the patient to.

Advantages and disadvantages

The disadvantage is the rare presence of the drug in pharmacies, a rather high price, as well as contraindications: virginity, the first trimester of pregnancy and lactation, organic lesions of the nervous system and impaired hematopoiesis. The drug should also not be used simultaneously with mechanical contraception, since the base of suppositories, as in the previous case, can destroy the latex.

Metronidazole+miconazole (Klion D)

Rating: 4.5

Klion D at a dosage of 100 mg of metronidazole and miconazole is another combined antimicrobial and antifungal drug from Gedeon Richter. 10 of these vaginal tablets can be bought at a price of 330 to 400 rubles. As in the previous case, the drug is active not only against Candida, but due to metronidazole, it destroys protozoa and anaerobes, bacteroids, fusobacteria, and pathogens such as Gardnerella vaginalis. The antifungal component miconazole causes an antifungal effect against yeast, dermatophytes, and especially sensitive Candida albicans. You need to enter one tablet per day, wetting the intravaginal tablet with water, the medicine must be used for 10 days, combined with taking metronidazole orally as prescribed by the doctor.

Advantages and disadvantages

This drug is highly effective in complicated forms of candidal vaginitis, and therefore it does not make sense to treat acute, simple vaginal candidiasis, this medicine is quite serious. The drug can also cause side effects associated with metronidazole. This is a metallic taste in the mouth, epigastric pain, constipation, decreased appetite, and dry mouth. There may be transient blurred vision, tinnitus, a decrease in the number of platelets in the blood plasma and an increase in the activity of liver enzymes, despite topical application of the drug. Of the contraindications, this is a reduced number of leukocytes, liver failure, pregnancy and lactation, as well as the age of up to 12 years in girls. The concomitant use of alcohol is strictly prohibited. There may be a teturam-like reaction: skin flushing, flushing, tachycardia, vomiting and discomfort.

Nystatin + nifuratel (Macmirror Complex)

Rating: 4.5

Macmirror complex is also a combined remedy that contains nifuratel and nystatin. The Italian company Doppel produces this remedy for candidiasis in the form of vaginal suppositories, and for 8 suppositories of 500 mg each, you will have to pay an average of 780 rubles. This medicine has shown high efficiency against protozoan fungi and bacteria, including Trichomonas. Nystatin is effective against Candida, and the combination of these drugs allows for a more pronounced antifungal effect, while expanding the spectrum of antimicrobial use. The medicine does not violate the physiological flora in the vagina, which avoids the development of chronic bacterial vaginosis. The medicine is prescribed intravaginally for 8 days according to the doctor’s recommendations, with the exception of the period of menstruation.

Advantages and disadvantages

This drug should also not be used in case of simple, catarrhal candidiasis of the vagina, but should be given in case of concomitant bacterial infection, or bacterial vaginosis. Of the side effects may be itching or skin rash, it is contraindicated in childhood, with hypersensitivity, as well as in pregnant and lactating women. In the case of a proven fungal or bacterial infection, it is necessary to simultaneously treat the sexual partner. But this recommendation applies to all drugs without exception, it is taken for granted, and is only sometimes reflected in the instructions for use.

Sertaconazole (Zalain)

Rating: 4.4

Finally, the last drug in our review will be Zalain, which is produced by the Hungarian company Egis in the form of vaginal suppositories. Just one suppository at a dosage of 300 mg will cost an average of 550 rubles. Zalain is indicated in various kinds of vaginitis due solely to candidiasis, so this remedy is highly specialized. Since the drug is very strong, then one suppository is the entire course of treatment, since a single administration is supposed. The suppository is inserted deep into the vagina, lying on your back before going to bed. If at the same time clinical symptoms persist, then repeated administration in a week is possible.

Advantages and disadvantages

A big advantage is just a one-time scheme of the type “accepted and forgotten.” The downside is the relatively high price. Zalain is rarely found in pharmacies, and it must be borne in mind that the drug has a very small list of contraindications: only individual intolerance. However, it is advisable not to use the drug for pregnant and lactating women, or to use it if the potential benefit to the mother outweighs the possible risk to the child.

Conclusion

In this review, in the vast majority of cases, various suppositories and suppositories were presented for the treatment of urogenital candidiasis. However, in the case of oral candidiasis, various antiseptics can be used. This is povidone-iodine, chlorhexidine, or miramistin: the oral cavity should be treated three times a day for two weeks.

If there are painful erosions under the raids, then local anesthetics, such as lidocaine hydrochloride, are used. It is applied for the purpose of anesthesia before eating, until the pain subsides. If there is an allergy to lidocaine, then either novocaine or a more powerful procaine can be used with caution.

What can be said about the famous nystatin? It is a very ancient drug among antifungal drugs, and resistance to it has long developed in a number of cases. But still, it retained its effectiveness in the event that it is applied topically. If it is prescribed in the form of tablets, then its effectiveness is lower, since it is not absorbed in the gastrointestinal tract, and comes out unchanged. You should not use Nystatin to combat oral candidiasis, but its combination with other drugs in vaginal suppositories is quite active and is used, including in pregnant women in the form of various ointments and creams. But even in this case, the course of treatment with nystatin should not be shorter than 7-10 days.

Attention! This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.