From the Guidelines
To treat thrush in a newborn, apply nystatin oral suspension to the affected areas in the baby's mouth using a clean finger or cotton swab, as it is a well-tolerated and effective treatment option 1. The typical dose is 1 ml (100,000 units) four times daily after feedings for 7-14 days. Continue treatment for 2-3 days after symptoms resolve to prevent recurrence. For breastfeeding mothers, treat your nipples with an antifungal cream like miconazole or clotrimazole to prevent reinfection. Keep bottle nipples, pacifiers, and breast pump parts clean by boiling or washing with hot, soapy water. Thrush appears as white patches on the tongue, gums, or inside the cheeks that don't wipe away easily. It's caused by an overgrowth of the Candida fungus, which naturally exists in the mouth but can multiply excessively, especially after antibiotic treatment. If symptoms don't improve within a week, or if your baby has difficulty feeding, contact your healthcare provider as a stronger medication may be needed 1.
Some key points to consider when treating thrush in newborns include:
- The use of nonabsorbable antifungal agents like nystatin to decrease the burden of Candida in the gut and prevent translocation into the bloodstream 1.
- The potential risks and benefits of different treatment options, including the risk of necrotizing enterocolitis (NEC) with nonabsorbable agents 1.
- The importance of proper hygiene and cleaning of equipment to prevent reinfection 1.
- The need for close monitoring and follow-up to ensure effective treatment and prevent complications 1.
In terms of specific treatment options, nystatin oral suspension is a recommended treatment for thrush in newborns, with a typical dose of 1 ml (100,000 units) four times daily after feedings for 7-14 days 1. Alternatively, fluconazole may be considered in certain cases, although the evidence for its use in newborns is limited 1. It's essential to consult with a healthcare provider to determine the best course of treatment for each individual case.
From the FDA Drug Label
Efficacy of fluconazole has not been established in infants less than 6 months of age. A small number of patients (29) ranging in age from 1 day to 6 months have been treated safely with fluconazole.
The FDA drug label does not provide a recommended treatment for thrush in newborns. However, it is noted that the efficacy of fluconazole has not been established in infants less than 6 months of age, but a small number of patients in this age range have been treated safely with the medication 2. For infants 6 months and older, fluconazole has been shown to be effective in the treatment of oropharyngeal candidiasis, with a clinical cure rate of 86% in one study 2.
- Key points:
- Efficacy not established in infants less than 6 months
- Small number of patients aged 1 day to 6 months treated safely
- Effective in infants 6 months and older for oropharyngeal candidiasis
- Recommended approach: Due to the lack of established efficacy in infants under 6 months, caution should be exercised when considering fluconazole for thrush treatment in newborns. It is essential to consult with a healthcare professional for guidance on the appropriate treatment.
From the Research
Treatment Options for Thrush in Newborns
- Fluconazole and nystatin are two common antifungal medications used to treat thrush in newborns 3, 4.
- Fluconazole has been shown to be more effective than nystatin in treating oral thrush in infants, with a clinical cure rate of 100% compared to 32% for nystatin 3.
- A study comparing fluconazole and nystatin in immunocompromised children found that fluconazole was more effective, with a clinical cure rate of 91% compared to 51% for nystatin 4.
Antifungal Activity and Interactions
- Nystatin, fluconazole, and capric acid have been tested for their antifungal activity against Candida isolates from neonatal oral thrush, with nystatin showing the lowest minimum inhibitory concentrations 5.
- The combination of capric acid with fluconazole or nystatin has been found to have synergistic, indifferent, and antagonistic interactions, with most cases showing indifferent interactions 5.
Comparison of Treatment Regimens
- A study comparing vaginal nystatin and oral fluconazole for the treatment of recurrent vulvovaginal candidiasis found that both treatments were effective, with mycological cure rates of 78.3% and 73.8% respectively 6.
- Another study found that fluconazole was more effective than nystatin in preventing Candida infections in patients with leukemia, with a success rate of 68% compared to 47% for nystatin 7.