Clotrimazole Troches vs Oral Nystatin for Oropharyngeal Candidiasis

To the Editor.  —As a medical oncologist in frequent need of treating symptomatic oral candidiasis, I read with astonishment the article by Gombert et al¹ entitled "A Comparative Trial of Clotrimazole Troches and Oral Nystatin Suspension in Recipients of Renal Transplants: Use in Prophylaxis of Oropharyngeal Candidiasis."Other dosage recommendations notwithstanding, I have for the past 12 years successfully treated patients with 1 mL of nystatin (100 000 U/mL) three times a day after meals to "swish and swallow." The great majority of patients achieve clearing of the candidiasis and I know of no evidence indicating that more frequent applications or larger doses are necessary or more effective, not to speak of outrageous amounts like 15 mL. The latter is analogous to the gustatory punishment an adult is subjected to when receiving appropriate doses of oral penicillin in the form of cherry-flavored pediatric syrup. The cost implications are also obvious: