What is the first-line topical medication prescribed for oral candidiasis?

Nystatin is a polyene antifungal that binds to ergosterol in the fungal cell membrane, creating pores that cause leakage of intracellular contents and cell death. It is not absorbed from the gastrointestinal tract, making it safe for topical oral use with minimal systemic side effects. It is the first-line treatment for mild-to-moderate oral candidiasis in immunocompetent patients. Formulations include oral suspension (swish and swallow/spit) and lozenges (troches). Fluconazole (systemic azole) is used for severe or recurrent cases, or in immunocompromised patients. Chlorhexidine has some antifungal activity but is not primary treatment.