What is the recommended treatment for oral thrush in a 2-week-old infant?

Treatment of Oral Thrush in a 2-Week-Old Infant

The recommended first-line treatment for oral thrush in a 2-week-old infant is nystatin oral suspension at a dose of 1 mL (100,000 units) four times daily for at least 48 hours after symptoms resolve. 1

Medication Options and Dosing

First-Line Treatment: Nystatin

• Dosage: 1 mL (100,000 units) four times daily 1, 2
  • For very young infants, administer using a dropper to place half of the dose in each side of the mouth 1
  • Avoid feeding for 5-10 minutes after administration 2
• Duration: Continue treatment for at least 48 hours after perioral symptoms have disappeared 1, 2
• Administration technique: Use dropper to place half of dose in each side of mouth to ensure proper coverage of affected areas 1, 2

Alternative Treatment: Fluconazole

• Consider only if nystatin treatment has failed 1
• Dosage: 3 mg/kg once daily for 7 days 1
• Note: Use is limited due to concerns about developing triazole resistance 1, 3

Treatment Monitoring

• Assess response to therapy after 2-3 days 1
• Continue treatment for at least 48 hours after symptoms resolve 1, 2
• Verify eradication with cultures when possible 1

Preventing Reinfection and Treatment Failure

• Sterilize pacifiers and bottle nipples regularly during treatment period 1
• If mother is breastfeeding and has nipple candidiasis, treat mother's nipples simultaneously 1
• Common causes of treatment failure:
  1. Inadequate duration of therapy
  2. Poor administration technique
  3. Failure to address potential sources of reinfection
  4. Stopping treatment prematurely 1

Special Considerations

• For premature and low birth weight infants, 1 mL of nystatin four times daily has been shown to be effective 2
• In nurseries with high rates of invasive candidiasis (>10%), prophylaxis may be considered for very low birth weight infants 1

Evidence Comparison

While a small pilot study from 2002 suggested fluconazole may be more effective than nystatin (100% vs 32% clinical cure rates) 4, current guidelines from the American Academy of Pediatrics still recommend nystatin as first-line therapy due to concerns about developing antifungal resistance with fluconazole 1. The FDA-approved labeling for nystatin also supports its use as first-line therapy in infants 2.

Risk Factors to Consider

• Recent antibiotic use in infant
• Maternal vaginal candidiasis during delivery 1
• Candida albicans is the most common causative organism 1, 5

Remember that proper administration technique and completing the full course of treatment are crucial for successful eradication of oral thrush in infants.