What is the recommended first-line topical antifungal treatment for mild-to-moderate oral candidiasis?

Clotrimazole troches (lozenges) are an effective first-line topical antifungal treatment for mild-to-moderate oral candidiasis. They are dissolved slowly in the mouth five times daily, allowing prolonged contact with oral mucosal surfaces. Clotrimazole acts by inhibiting ergosterol synthesis, disrupting fungal cell membrane integrity. Nystatin oral rinse is also effective but has a less pleasant taste and requires four-times-daily rinsing and swallowing; it is often second-line. Fluconazole is reserved for moderate-to-severe cases, refractory infections, or immunocompromised patients. For inhaler-induced candidiasis, improving inhaler technique (spacer use) and rinsing with water after use are important adjuncts.