Fungal infections

Superficial fungal infections can be treated in a primary care setting.

Chronic hyperplastic candidosis (candidal leukoplakia) is potentially premalignant and therefore refer patients with this condition for specialist treatment.

Treatment with nystatin, a topical antifungal agent, is effective against superficial infections but compliance is poor because of its unpleasant taste. Miconazole or the systemically absorbed drug fluconazole can be prescribed as alternatives unless contraindicated. 

Note that fluconazole interacts with many drugs, including warfarin and statins, and therefore do not give fluconazole to patients taking these drugs. In addition, avoid the use of miconazole, a topical azole antifungal agent, in such patients because sufficient drug is absorbed to cause similar interactions.