From the Guidelines
Gentian violet is the 'purple stuff' commonly used to treat persistent oral thrush (candidiasis) in young children when nystatin has failed. For a 21-month-old child, a 0.5-1% solution of gentian violet can be applied to the affected areas of the mouth using a cotton swab, typically twice daily for 3-4 days. The application should be done carefully to avoid staining clothes and skin, and the child should not eat or drink for about 30 minutes afterward. Gentian violet works by directly killing the Candida fungus and has been used for decades as an antifungal agent. It's particularly useful for resistant cases because it has a different mechanism of action than nystatin. Some key points to consider when using gentian violet include:
- The child's mouth will be temporarily stained purple
- Excessive use should be avoided as it may irritate the mucous membranes
- If thrush persists after gentian violet treatment, a medical professional should be consulted as systemic antifungal medications might be needed According to the most recent guidelines 1, treatment of oral thrush should be based on the severity of the disease, and gentian violet is not explicitly mentioned as a recommended treatment. However, it is a commonly used alternative for resistant cases. The guidelines do recommend fluconazole as a treatment option for moderate to severe disease 1.
From the FDA Drug Label
Pediatric Studies Oropharyngeal candidiasis: An open-label, comparative study of the efficacy and safety of fluconazole (2 to 3 mg/kg/day) and oral nystatin (400,000 I. U. 4 times daily) in immunocompromised children with oropharyngeal candidiasis was conducted.
The 'purple stuff' used to treat persistent oral thrush (candidiasis) in a 21-month-old child after nystatin treatment is likely gentian violet, although it is not explicitly mentioned in the provided drug label. However, based on the context of the question and common medical practices, gentian violet is a topical antifungal agent that is sometimes used to treat oral thrush, especially in cases where other treatments like nystatin have failed. It is essential to consult a healthcare professional for an accurate diagnosis and appropriate treatment. 2
From the Research
Treatment for Persistent Oral Thrush
The 'purple stuff' used to treat persistent oral thrush (candidiasis) is likely gentian violet.
- Gentian violet is a topical antifungal agent that has been compared to nystatin oral suspension for the treatment of oropharyngeal candidiasis in HIV-1-infected participants 3.
- In one study, gentian violet was found to be as effective as nystatin oral suspension in treating oropharyngeal candidiasis, with no significant difference in cure rates between the two arms 3.
- Gentian violet has also been shown to be effective in treating oral candidiasis in adults with HIV infection, with a study finding that it was superior to nystatin in bringing about clinical cure 4.
- Another study found that local application of 1% gentian violet was effective in eradicating Candida glabrata infection in a patient who had failed to respond to other treatments 5.
Advantages of Gentian Violet
- Gentian violet is a low-cost alternative to other antifungal agents, with one study finding that its procurement cost was significantly lower than that of nystatin oral suspension 3.
- Gentian violet is also well-tolerated, with no significant adverse events reported in one study 3.
- However, gentian violet can cause staining, with one study finding that 61% of participants reported 'no' staining and 39% reported 'mild-to-moderate' staining 3.
Other Treatment Options
- Other treatment options for oral thrush include fluconazole, ketoconazole, clotrimazole, and posaconazole 4, 6.
- These agents have been shown to be effective in treating oral candidiasis, but may have different efficacy and safety profiles compared to gentian violet.
- The choice of treatment will depend on various factors, including the severity of the infection, the patient's medical history, and the presence of any underlying conditions.