From the Guidelines
For neonates, thrush should be treated with nystatin oral suspension, while milk residue requires no medical treatment, only proper oral hygiene. When distinguishing between oral thrush and milk residue in neonates, it's crucial to look for specific characteristics. Oral thrush presents as white patches on the tongue, gums, and inside cheeks that don't wipe away easily and may bleed if scraped, while milk residue appears as a thin white film that can be easily wiped away without bleeding. For thrush treatment, the use of antifungal medications is essential. Although the provided evidence 1 focuses on systemic candidiasis treatment, including recommendations for amphotericin B deoxycholate and fluconazole for disseminated candidiasis, the principle of antifungal treatment applies. However, for oral thrush in neonates, nystatin oral suspension is typically recommended, administered 1 mL to each side of the mouth four times daily after feedings for 7-14 days. Key considerations for treatment include:
- Ensuring the medication contacts all oral surfaces
- Continuing treatment for 48 hours after symptoms resolve to prevent recurrence
- Treating breastfeeding mothers' nipples with nystatin cream or miconazole to prevent reinfection Milk residue, on the other hand, requires no treatment beyond normal oral hygiene - simply wiping the baby's mouth with a clean, damp cloth after feedings. It's essential to note that thrush occurs due to Candida albicans overgrowth, often following antibiotic treatment or when passed from mother to baby during delivery or breastfeeding. If thrush persists despite initial treatment, consulting a pediatrician for further guidance, including the potential use of fluconazole as a second-line option, is necessary due to the need for careful dosing in neonates.
From the FDA Drug Label
INDICATIONS AND USAGE Nystatin Oral Suspension, USP, is indicated for the treatment of candidiasis in the oral cavity. The FDA drug label does not answer the question.
From the Research
Thrush versus Milk in Neonates
- Thrush, also known as oral candidiasis, is a common infection in neonates, caused by the fungus Candida albicans 2.
- Milk, on the other hand, is a common substance that can come into contact with a neonate's mouth, potentially contributing to the development of thrush.
Treatment Recommendations for Thrush
- Topical antifungal agents such as nystatin and miconazole are commonly used to treat oral candidiasis in neonates 3, 2.
- Systemic antifungal agents such as fluconazole may be used in severe cases or when topical treatment is not effective 3, 4.
- Resistance to antifungal agents is a concern, with some studies showing resistance to fluconazole and other agents 2, 5.
Treatment Recommendations for Milk-Related Issues
- There is no direct evidence to suggest that milk itself needs to be treated, but rather that good hygiene practices should be followed to prevent the spread of infection 2.
- If a neonate is experiencing thrush, it is recommended to continue breastfeeding, but to also treat the infection with antifungal agents 3, 4.
Comparison of Treatment Options
- Nystatin and miconazole are effective topical treatments for oral candidiasis, but may require a long course of treatment 3, 2.
- Fluconazole is an effective systemic treatment, but may be associated with resistance and other side effects 3, 4, 5.
- Clotrimazole and itraconazole are also effective treatments, but may have varying degrees of efficacy and patient acceptability 3, 4, 5.