From the Guidelines
The treatment for oral candidiasis (thrush) in a 5-month-old infant typically involves nystatin oral suspension, as recommended by the most recent and highest quality study 1. The recommended dosage is 1-2 mL (100,000-200,000 units) four times daily, applied directly to the affected areas of the mouth using a clean finger or cotton swab. Each dose should be administered after feedings, and treatment should continue for 48 hours after symptoms resolve, usually for 7-14 days total. For persistent cases, fluconazole oral suspension may be prescribed at 3-6 mg/kg on the first day, followed by 3 mg/kg once daily for 7-14 days, as suggested by 1 and 1. It's essential to also treat any pacifiers, bottle nipples, or breast nipples (if breastfeeding) by boiling or replacing them to prevent reinfection. The mother should be treated with an antifungal cream on her nipples if breastfeeding to prevent passing the infection back and forth. Thrush occurs because infants have immature immune systems that allow the Candida fungus, normally present in small amounts, to overgrow. Treatment works by directly killing the fungus while the infant's immune system develops further protection against recurrence. Key considerations in managing thrush include:
- Using nystatin oral suspension as the first-line treatment
- Considering fluconazole for persistent cases
- Preventing reinfection by treating pacifiers, bottle nipples, and breast nipples
- Treating the mother's nipples if breastfeeding to prevent passing the infection back and forth. Overall, the goal of treatment is to effectively manage the infection, prevent recurrence, and promote the infant's overall health and well-being, as emphasized by 1 and 1.
From the FDA Drug Label
Infants: 2 mL (200,000 units) four times daily (in infants and young children, use dropper to place one-half of dose in each side of mouth and avoid feeding for 5 to 10 minutes)
The treatment for oral candidiasis (thrush) in a 5-month-old infant is nystatin (PO) with a dose of 2 mL (200,000 units) four times daily. The dose should be administered using a dropper, placing one-half of the dose in each side of the mouth, and avoiding feeding for 5 to 10 minutes. Treatment should be continued for at least 48 hours after perioral symptoms have disappeared and cultures demonstrate eradication of Candida albicans 2.
From the Research
Treatment Options for Oral Candidiasis (Thrush) in Infants
- The treatment for oral candidiasis (thrush) in a 5-month-old infant can involve the use of antifungal medications such as fluconazole and nystatin 3, 4.
- Fluconazole has been shown to be more effective than nystatin in treating oral thrush in infants, with clinical cure rates of 100% compared to 32% for nystatin in one study 3.
- Another study found that fluconazole suspension was more effective than nystatin in treating oropharyngeal candidiasis in immunocompromised children, with clinical cure rates of 91% compared to 51% for nystatin 4.
Administration and Dosage
- Fluconazole can be administered as a single daily dose of 3 mg/kg for 7 days 3 or 2 to 3 mg/kg per day for 14 days 4.
- Nystatin can be administered as an oral suspension four times a day for 10 days 3 or 400,000 units four times daily for 14 days 4.
Efficacy and Safety
- Both fluconazole and nystatin have been shown to be well-tolerated in infants and children, with similar frequencies of adverse events 4, 5.
- However, fluconazole may be more effective in preventing Candida infections in patients with leukemia 5.
- The use of capric acid, nystatin, and fluconazole has also been studied, with results showing that these antifungal agents can be effective against Candida isolates from neonatal oral thrush 6.