What is the recommended treatment for oral thrush in an 11-month-old male weighing 10.4 kilograms (kg)?

Treatment of Oral Thrush in an 11-Month-Old Male Weighing 10.4 kg

The recommended first-line treatment for oral thrush in an 11-month-old child is nystatin oral suspension at a dose of 2 mL (200,000 units) four times daily, with half the dose placed on each side of the mouth. 1

Treatment Options and Dosing

First-Line Treatment:

• Nystatin oral suspension:
  • Dosage: 2 mL (200,000 units) four times daily 1
  • Administration: Use dropper to place one-half of dose in each side of mouth
  • Duration: Continue treatment for at least 48 hours after symptoms have disappeared and cultures demonstrate eradication of Candida albicans 1
  • Avoid feeding for 5-10 minutes after administration to maximize contact time

Alternative Treatment (if nystatin fails):

• Fluconazole oral suspension:
  • Loading dose: 6 mg/kg on first day (approximately 62 mg)
  • Maintenance dose: 3 mg/kg once daily (approximately 31 mg) 2
  • Duration: Minimum of 7-14 days, and at least 2 weeks following resolution of symptoms 2

Treatment Algorithm

1. Start with nystatin oral suspension as first-line therapy
2. Assess response after 72 hours
3. If improving: Continue nystatin for at least 48 hours after symptoms resolve
4. If not improving after 3-5 days: Consider switching to fluconazole
5. If severe or refractory: Consult pediatric infectious disease specialist

Practical Administration Tips

• Nystatin administration:

  • Apply after feeding to maximize contact time
  • Use the dropper to place medication directly on affected areas
  • Have the child avoid drinking/eating for 5-10 minutes after administration
  • Shake suspension well before each use

• Fluconazole administration:

  • Can be given with or without food 2
  • Administer at the same time each day

Important Considerations

• Assess for underlying causes:

  • Recent antibiotic use
  • Immunocompromised status
  • Poor oral hygiene
  • Use of inhaled corticosteroids

• Supportive measures:

  • Maintain good oral hygiene
  • Clean pacifiers, bottles, and toys regularly
  • For breastfed infants, consider treating mother's nipples if they show signs of infection

Monitoring

• Follow-up within 1 week to assess treatment response
• Monitor for side effects:
  • Nystatin: Minimal systemic absorption, generally well-tolerated
  • Fluconazole: Monitor for gastrointestinal upset, rash, or elevated liver enzymes (rare in short courses)

Cautions

• Fluconazole should be reserved for cases that fail to respond to nystatin due to its systemic effects
• Adjust fluconazole dosing in patients with renal impairment 2
• Persistent or recurrent thrush may indicate an underlying condition requiring further investigation 3, 4