What is the recommended dose of nystatin (antifungal medication) for children?

Nystatin Dosing for Children

For children with oral candidiasis (thrush), the recommended nystatin dose is 4-6 mL (400,000-600,000 units) of oral suspension four times daily, while infants should receive 2 mL (200,000 units) four times daily. 1

Dosing Recommendations by Age Group

Infants

• Standard dose: 2 mL (200,000 units) four times daily 1
• Premature and low birth weight infants: 1 mL (100,000 units) four times daily 1
• Place one-half of dose in each side of mouth
• Avoid feeding for 5-10 minutes after administration

Children

• Standard dose: 4-6 mL (400,000-600,000 units) four times daily 1
• Place one-half of dose in each side of mouth
• Medication should be retained in mouth as long as possible before swallowing

Duration of Therapy

• Continue treatment for at least 48 hours after symptoms have disappeared and cultures demonstrate eradication of Candida albicans 1
• For oropharyngeal candidiasis: 7-14 days is typically recommended 2

Prophylactic Use in Neonates

For very low birth weight infants (<1500g) in NICUs with high rates of invasive candidiasis:

• Oral nystatin: 1 mL (100,000 IU/mL) every 8 hours during high-risk period 2
• This approach has shown reduction in fungal infection but no change in mortality 2

Clinical Considerations

Efficacy Comparison

• Fluconazole has demonstrated superior efficacy to nystatin in treating oral thrush in infants (100% vs 32% clinical cure rates) 3
• However, nystatin remains a viable option, particularly when there are concerns about antifungal resistance 4

Alternative Treatments

For moderate to severe oropharyngeal candidiasis:

• Oral fluconazole: 100-200 mg (3 mg/kg) daily for 7-14 days 2
• For fluconazole-refractory disease: itraconazole solution or posaconazole suspension 2

Administration Tips

• Ensure proper administration technique for optimal efficacy
• For infants: use dropper to place medication in each side of mouth
• For denture-related candidiasis: disinfection of denture in addition to antifungal therapy 2

Common Pitfalls

1. Inadequate duration of therapy leading to recurrence
2. Poor administration technique reducing medication effectiveness
3. Failure to continue treatment after clinical symptoms resolve
4. Not recognizing when to escalate to systemic therapy for invasive infections

Nystatin is generally well-tolerated with minimal systemic absorption, making it a safe option for children with oral candidiasis. However, for invasive fungal infections, systemic antifungal therapy is always required rather than topical nystatin.