I just got over a long dose of pred and antibiotics due to a bad
respiratory infection.

I got a bad thrush infection that wouldn't clear up for awhile and the
Mycostatin suspension didn't work so I called my dentist and he
ordered Mycostatin lozenges and they worked.

I was also doing the acidophilus also. I had been put on the Advair
500 2x's a day while sick and was rinsing and gargling after using the
Advair.

One thing my dentist told me to do is to get cheap toothbrushes and
change them until the thrush left. Your toothbrush carries the thrush
on it.

I am now free from the thrush, but it seemed that the lozenges and the
clean toothbrushes helped the most.

Reason for the dentist call, is that there was a big mix-up with the
pharmacy not getting my lozenges and then saying they had no record
that I gave them the prescription from my doctor so I got tired of the
thrush growing and after a week and a half of waiting and calling to
see if the med was in, I called my dentist.

Michelle

The changing tooth brushes suggestion just might work. You also should be
checked for diabetes and other medical problems. The candida species (yeast)
that overgrow and cause thrush (the same as cause "yeast infections" in
women and diaper rashes in babies) are a normal part of your gut flora and
so it is unlikely that you will ever completely eradicate it for long. [That
is also why "systemic candiasis" tests/cultures of the stool are so
profitable - everyone has it.] Probitotics, like the acidophilus and yogurt
with live cultures can help to restore the flora that usually compete with
the candida and keep it in check. As you have learned, rinsing after using
the inhaler is extremely important.

To be honest I have never used Gentian Violet for more than a single
treatment in infants and have never read any reports of how much is too
much. I did try to find the information and could not find any specific
dosing information or reports of toxicity for humans (the good news). I did
find studies in rats showing liver cancer in rats fed very high doses and
studies showing DNA damage to the epithelial cells of the gut in rats so it
does appear to cause cancer in high doses to rats (the bad news). It is
impossible to translate this into a specific dose recommendation for people
but it does suggest that it is probably not a great long term solution.

So what can you do (besides rinse, change tooth brushes, and take
probiotics)?

One thing you can do is to reduce the mouth's exposure to steroids. One way
to do this is to lower your need for steroids by controlling exposure to
triggers, aggressively looking for other triggers (like sinus disease and
possibly reflux) and using other meds like Singulair/Accolate, long acting
dilators (as is in Advair), theophylline, possibly antihistamines, and
immunotherapy (allergy shots).

You can reduce the effect of the residue in the mouth by leaving less
residue (and rinsing). One way to do this is to go to once daily dosing of
the inhaled steroid (twice as much once a day). Most inhaled steroids were
never approved to be used this way but that is just because they were never
tested that way. Oral steroids work very well taken once a day and there is
no reason to suspect that the inhaled steroids will be any different. You
could also switch to a less potent steroid like Azmacort. You would have to
take more of it and would be exposed to higher systemic absorption but the
effect in the mouth would be less. Qvar is a newer medicine that is both
less potent topically (it is the older drug beclomethasone) and might have
better deposition. Using a spacer with the older types of inhalers (like
regular Flovent) is a must or switching to a newer "HFA" type inhaler (like
Fovent HFA or Qvar) might help leave less residue.

One note: You can't just take Advair once a day. With this you would need to
have them split it into the component drugs (Flovent and Serevent) and take
the Flovent twice as much once daily and the Serevent as prescribed twice
daily.

Lastly, you could just go on a maintenance schedule of antifungals. Nystatin
suspension ("swish and swallow") and Mycelex troches are common. A more
convenient choice might be oral fluconazole (Diflucan). You may be able to
take one pill every 1 or possibly several weeks to keep the problem at bay.
The main problem with fluconazole is that it has a lot of drug interactions
(including theophylline) so the doc would have to keep an eye on your med
list.

http://www.emedicine.com/PED/topic312.htm

http://www.drugs.com/MTM/fluconazole.html

Maggie:
I too have suffered from thrush from Advair. Mine was at the back of my
mouth. No matter how much rinsing or what I rinsed with including
mouthwash my thrush would keep coming back and then not go away without
treatment.
I recently switched to Asmanex a once a day treatment for Asthma and it
is amazing how fast my thrush started going away.
Also make sure you concentrate to keep your tongue down and flat while
inhaling these steroid medications. My tongue tends to have a habit of
jumping up now and again which increases my chances of getting thrush
on the back of my mouth.

ncchinagirl

Maggie, do you rinse your mouth out and have a drink just prior to taking
the meds ?
Also, do you tilt your chin up a bit, so there is a straighter route to your
lungs, and not such an impact on the back of your throat,which keeps some of
the med in your mouth ?
Easy things to try, and it may help you like it has helped me.
All the best,
Sheila (cranky)