From the Guidelines
The recommended treatment for oral thrush in a 19-month-old child is nystatin oral suspension, as it is a safe and effective option for this age group. The typical dosage is 1-2 ml (100,000-200,000 units) four times daily, applied directly to the affected areas with a clean finger or cotton swab, as suggested by guidelines for treatment of candidiasis 1. Each dose should be administered after meals and at bedtime, and the medication should be swished around the mouth before swallowing. Treatment usually continues for 7-14 days, and should extend at least 48 hours after symptoms resolve. Parents should clean the child's mouth gently before each application, ideally with a soft cloth dampened with warm water. If symptoms don't improve within a week, or if the child has difficulty eating or drinking, a healthcare provider should be consulted. Nystatin works by binding to ergosterol in the fungal cell membrane, creating pores that lead to cell death. It's essential to complete the full course of treatment even if symptoms improve quickly to prevent recurrence. For children who use pacifiers or bottles, these items should be sterilized daily during treatment to prevent reinfection. Although other options like fluconazole are available, nystatin is preferred for its safety profile in young children, and fluconazole prophylaxis is typically recommended for neonates with birth weights <1000 g in nurseries with high rates of invasive candidiasis 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION 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 recommended treatment for oral thrush in a 19-month-old child is Nystatin (PO) with a dose of 2 mL (200,000 units) four times daily. It is advised to use a dropper to place one-half of the dose in each side of the mouth and avoid feeding for 5 to 10 minutes. Treatment should be continued for at least 48 hours after perioral symptoms have disappeared 2.
- Key points:
- Dose: 2 mL (200,000 units) four times daily
- Administration: one-half of the dose in each side of the mouth
- Duration: at least 48 hours after symptoms have disappeared
From the Research
Treatment Options for Oral Thrush in a 19-Month-Old Child
The treatment for oral thrush in a 19-month-old child can vary depending on the severity of the condition and the child's overall health.
- Nystatin oral suspension is a common treatment for oral thrush in infants, but it has been associated with frequent recurrences and difficulty in administration 3.
- Fluconazole suspension has been shown to be superior to nystatin suspension in the treatment of oral thrush in otherwise healthy infants, with a clinical cure rate of 100% compared to 32% for nystatin 3.
- Miconazole gel has also been found to be effective in treating oropharyngeal candidiasis in immunocompetent infants, with a clinical cure rate of 96.9% compared to 37.6% for nystatin suspension 4.
- In immunocompromised children, fluconazole suspension has been shown to be more effective than nystatin in the treatment of thrush, with a clinical cure rate of 91% compared to 51% for nystatin 5.
Considerations for Treatment
When considering treatment for oral thrush in a 19-month-old child, it is essential to take into account the child's overall health and any potential allergies or interactions with other medications.
- The most common initial treatment for oral thrush in breastfeeding infants is oral nystatin, followed by oral fluconazole for the mother 6.
- Prophylactic administration of oral nystatin has been shown to reduce the risk of invasive candidiasis in extremely low-birth-weight and very low-birth-weight infants 7.
- The choice of treatment should be based on the severity of the condition, the child's age and health status, and the potential risks and benefits of each treatment option 3, 6, 4, 5.