From the Guidelines
Oral thrush in infants should be treated with nystatin oral suspension, typically 1 ml (100,000 units) applied to each side of the mouth four times daily after feedings for 7-14 days. This treatment is based on the most recent and highest quality study available, which recommends the use of nystatin oral suspension for the treatment of oral candidiasis in infants 1. The symptoms of oral thrush in infants include white patches on the tongue, inside of the cheeks, and gums, as well as difficulty feeding and irritability.
Treatment Options
- Apply nystatin oral suspension using a clean finger or cotton swab, coating the inside of the cheeks, gums, and tongue
- Continue treatment for 48 hours after symptoms resolve to prevent recurrence
- For breastfed infants, mothers should also apply nystatin cream to their nipples to prevent reinfection
- Sterilize pacifiers, bottle nipples, and toys that go in the baby's mouth daily during treatment
Prevention of Recurrence
- Good oral hygiene practices, such as cleaning the infant's mouth with a clean cloth after feedings, can help prevent the recurrence of oral thrush
- Avoiding the sharing of pacifiers, bottle nipples, and toys can also help prevent the spread of Candida albicans
Monitoring and Follow-up
- Contact your pediatrician if symptoms persist beyond two weeks or if the infant develops difficulty feeding or appears uncomfortable
- Follow-up appointments with your pediatrician may be necessary to monitor the infant's response to treatment and to prevent recurrence. The most recent study on the management of candidiasis recommends that treatment be continued for 2 weeks after documented clearance of Candida species from the bloodstream and resolution of signs attributable to candidemia 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 preparation should be retained in the mouth as long as possible before swallowing. Continue treatment for at least 48 hours after perioral symptoms have disappeared and cultures demonstrate eradication of Candida albicans.
The symptoms of oral candidiasis (thrush) in an infant are not explicitly stated in the provided drug labels. However, the treatment option for oral candidiasis (thrush) in an infant is nystatin (PO), with a recommended dose of 2 mL (200,000 units) four times daily 2. It is essential 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 continue for at least 48 hours after perioral symptoms have disappeared and cultures demonstrate eradication of Candida albicans. Fluconazole (PO) can be used to treat oropharyngeal candidiasis in children, but its efficacy has not been established in infants less than 6 months of age 3. In a study, fluconazole was shown to be effective in the treatment of oropharyngeal candidiasis in children 6 months to 13 years of age, with a clinical cure rate of 86% compared to 46% for nystatin 3.
From the Research
Symptoms of Oral Candidiasis (Thrush) in Infants
- White plaques on the oral mucosa are a common symptom, although some cases may not present with visible plaques 4
- Infection with Candida albicans can cause extreme pain in the breastfeeding mother and may lead to premature weaning 5
Treatment Options for Oral Candidiasis (Thrush) in Infants
- Nystatin oral suspension is a common initial treatment, although it is associated with frequent recurrences and difficulty in administration 6, 5, 7
- Fluconazole suspension has been shown to be superior to nystatin suspension in terms of efficacy, rapidity of achieving cure, and oropharyngeal yeast eradication 6, 8
- Miconazole gel is also an effective treatment option, with a higher clinical cure rate compared to nystatin suspension 7
- Treatment of recurrence or persistence may involve oral fluconazole for both the mother and infant 5
Comparison of Treatment Options
- Fluconazole has been shown to be more effective than nystatin in several studies, with clinical cure rates ranging from 91% to 100% 6, 8
- Miconazole gel has also been shown to be more effective than nystatin suspension, with a clinical cure rate of 96.9% by Day 8 of treatment 7
- Nystatin suspension has a lower clinical cure rate, ranging from 21.2% to 54.1% 6, 7