From the Guidelines
For pediatric oral thrush, fluconazole (Diflucan) is typically dosed at 6 mg/kg on the first day, followed by 3-6 mg/kg once daily for 7-14 days, as recommended by the most recent guidelines 1. The dosage may vary depending on the severity of the infection and the patient's response to treatment.
- The medication can be administered as an oral suspension for easier administration to young children.
- Before starting treatment, it's essential to confirm the diagnosis of oral thrush, which appears as white patches on the oral mucosa that cannot be easily wiped away.
- Fluconazole works by inhibiting fungal cytochrome P450 enzymes, preventing the synthesis of ergosterol, an essential component of fungal cell membranes.
- Common side effects may include nausea, abdominal pain, and diarrhea.
- Liver function should be monitored in prolonged treatment courses, especially in patients with pre-existing liver disease.
- It's also important to note that fluconazole has potential drug interactions, particularly with antiretroviral drugs, and should be used cautiously in these situations 1.
- The pharmacokinetics of fluconazole vary significantly with age, and children may require higher doses to achieve comparable drug exposure 1.
From the FDA Drug Label
Oropharyngeal candidiasis: The recommended dosage of fluconazole tablets for oropharyngeal candidiasis in children is 6 mg/kg on the first day, followed by 3 mg/kg once daily. Treatment should be administered for at least 2 weeks to decrease the likelihood of relapse The recommended dose of Diflucan (fluconazole) for oral thrush in pediatric patients is 6 mg/kg on the first day, followed by 3 mg/kg once daily. Treatment should be administered for at least 2 weeks to decrease the likelihood of relapse 2.
From the Research
Diflucan Dose in Oral Thrush Pediatrics
The recommended dose of Diflucan (fluconazole) for oral thrush in pediatric patients varies based on the patient's age and weight.
- For infants, a study 3 compared fluconazole with nystatin for the treatment of oral candidiasis, with fluconazole given as 3 mg/kg in a single daily dose for 7 days, showing superior results to nystatin.
- Another study 4 in immunocompromised children used a single daily dose of fluconazole suspension, 2 to 3 mg/kg per day, demonstrating higher efficacy compared to nystatin.
- A review 5 on the administration of fluconazole in children below 1 year of age suggests a recommended daily dosage of 6 mg/kg, with adjustments for patients with impaired renal function and neonates.
Dosage Considerations
- The dosage may need to be adjusted based on the patient's renal function and age, especially in neonates where the dosage should be administered less frequently in the first few weeks of life 5.
- It's essential to monitor drug levels during treatment to ensure therapeutic plasma concentrations of fluconazole 5.