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The Thrush Surge: Why More Mouths Are Getting Caught Off-Guard

Logan Anderson, Pharm.D., RPh
Logan Anderson, Pharm.D., RPh

Galt Pharmaceuticals

Recent Trends in Oral Thrush

Candida species are the most common culprit of all fungal diseases. Oral thrush, where Candida species invade the mouth and throat, is a particularly prevalent form of fungal infection. In a healthy population, Candida species are isolated from the mouth in 75% of individuals.1 These colonies wait for the opportunity to strike and flourish, creating animbalance in the microflora.

There is heightened concern for patients with HIV, who are most at risk of an infection due to their weakened immune system. Though, patients without an underlying condition that compromises their immune system are also at risk of infection.

Once Candida has colonized the mouth, it can spread to the blood or other organ systems.One-and-a-half million people yearly experience invasive candidiasis or candidemia(bloodstream infection), with a fatality rate of over 60%.2

“Oropharyngeal candidiasis (Oral Thrush)
is reported as one of the most prevalent
opportunistic infections in the advanced
HIV disease population”
Global Guideline for the Diagnosis and Management of
Candidiasis (2025)3

The primary species responsible for oral thrush is Candida albicans (CA), though non-albicans Candida (NCA) may be on the rise. This change could pose a problem for treatment strategies.

A recent analysis of 1286 patients found that 67% of positive fungal cultures contained CA, while 33.21% contained NAC. These NAC strains were especially resistant to treatment with common antifungals. As expected, patients with poor oral hygiene, dry mouth, uncontrolled diabetes, or an immunosuppressive condition were at increased risk of infection.4

Future Treatment Goals

Diagnosis of Candida infections can be slow as cultures may take one to two days to grow before identification is possible, resulting in delayed treatment.

Currently, there are limited options for non-culture-based diagnostic tools for Candida species. Research is being conducted on identification methods that involve polymerase chain reaction (PCR) tests. Focus is put on creating assay panels which test for multiple ‘priority pathogens’, such as Candida or Aspergillus species, to help narrow down the causative pathogen in a single step.

Another barrier to treating oral thrush is complex treatment regimens. As many regimens can involve taking four to five doses per day for two weeks, patients are susceptible to missing doses throughout the course of therapy. Non-adherence to the full regimen may not sufficiently eradicate the Candida infection and could even be harmful for the patient by promoting resistance to that treatment.

In cases where patient adherence to the treatment regimen is a concern, providers should consider once-daily treatment regimens to ensure the full course of therapy is taken.

References

  1. Stoopler ET, Villa A, Bindakhil M, Díaz DLO, Sollecito TP. Common Oral Conditions: A Review. JAMA. 2024;331(12):1045–1054. doi:10.1001/jama.2024.0953
  2. World Health Organization. Landscape Analysis of Commercially Available and Pipeline In Vitro Diagnostics for Fungal Priority Pathogens. Geneva, Switzerland: World Health Organization; 2025. ISBN: 978-92-4-010553-9.
  3. Global guideline for the diagnosis and management of candidiasis: an initiative of the ECMM in cooperation with ISHAM and ASM. Cornely, Oliver A et al. The Lancet Infectious Diseases, Volume 25, Issue 5, e280 – e293.
  4. Tkaczyk M, Kuśka-Kielbratowska A, Fiegler-Rudol J, Niemczyk W, Mertas A, Skaba D, Wiench R. The Prevalence and Drug Susceptibility of Candida Species and an Analysis of Risk Factors for Oral Candidiasis—A Retrospective Study. Antibiotics. 2025; 14(9):876. https://doi.org/10.3390/antibiotics14090876

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