What is the best course of treatment for a 15-month-old child with oral thrush and diarrhea for 2 weeks?

Treatment for a 15-Month-Old with Oral Thrush and Diarrhea

For a 15-month-old child with oral thrush and diarrhea for 2 weeks, the best treatment approach is oral nystatin suspension (200,000 units four times daily) for thrush while focusing on oral rehydration therapy with reduced osmolarity ORS for diarrhea management. 1, 2

Oral Thrush Management

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

Diarrhea Management

Assessment of Dehydration

• Evaluate for signs of dehydration:
  • General appearance
  • Eyes (sunken or not)
  • Mucous membranes (dry or moist)
  • Tears (present or absent)
  • Capillary refill time (normal < 2 seconds)
  • Urine output
  • Vital signs, especially heart rate and blood pressure 2

Rehydration Strategy

• Primary approach: Reduced osmolarity oral rehydration solution (ORS) for mild to moderate dehydration 2

  • Standard composition: 75-90 mEq/L sodium, 20 mEq/L potassium, 65-80 mEq/L chloride, 10 mEq/L citrate, and 75-111 mmol/L glucose
  • Commercial preparations are preferred over homemade solutions 3
  • Target volume: 25 mL/kg or more during initial rehydration phase 4

• If severe dehydration is present (unlikely to tolerate oral intake, altered mental status):

  • Refer for intravenous fluid therapy 2

Dietary Recommendations

• Continue age-appropriate diet during or immediately after rehydration 2
• Offer food every 3-4 hours 2
• Follow BRAT diet principles (bread, rice, applesauce, toast) 2
• Avoid:
  • Lactose-containing products temporarily
  • Foods high in simple sugars and fats
  • High-osmolar supplements 2

Important Cautions

• Do NOT use antimotility drugs (e.g., loperamide) as they are contraindicated in children under 2 years 2
• Antibiotics are generally not indicated for uncomplicated diarrhea in children 2, 3, 5
• If diarrhea persists beyond 2 weeks (as in this case), consider:
  • Stool analysis for blood, leukocytes, ova and parasites
  • Stool culture for bacterial pathogens
  • Complete blood count and electrolyte panel 2, 6

Monitoring and Follow-up

• Monitor hydration status through:

  • Changes in weight
  • Urine output
  • Complaints of thirst 2

• Seek immediate medical attention if:

  • No improvement within 48 hours
  • Worsening symptoms
  • Development of warning signs (severe vomiting, increased dehydration, persistent fever, abdominal distension, blood in stool) 2

Prevention Measures

• Emphasize proper hand hygiene to prevent spread of infection 2
• Ensure appropriate infection control measures at home 2
• Consider rotavirus vaccination status for future prevention 2

Clinical Pearls

• The combination of oral thrush and persistent diarrhea warrants careful evaluation for underlying conditions that may affect immune function
• Early reintroduction of normal diet is important for recovery and to prevent nutritional deficiencies 7
• Oral rehydration therapy has been shown to be as effective as intravenous fluid in managing mild to moderate dehydration with many advantages 7