What is the treatment plan for oral thrush in an 11-month-old infant?

Treatment of Oral Thrush in an 11-Month-Old Infant

For oral thrush in an 11-month-old infant, nystatin oral suspension 1 mL (100,000 units) four times daily for 7-14 days is the recommended first-line treatment. 1, 2

First-Line Treatment Options

• Nystatin oral suspension (100,000 units/mL): 1 mL four times daily for 7-14 days 1, 2
  • Administration technique: Use dropper to place one-half of dose in each side of mouth and avoid feeding for 5-10 minutes afterward 2
  • Continue treatment for at least 48 hours after symptoms have disappeared 2

Alternative Treatment Options (If Nystatin Fails)

• Fluconazole oral suspension: 3-6 mg/kg daily for 7 days 1, 3, 4

  • Higher efficacy rate compared to nystatin (100% vs 32% in one study) 4
  • Advantage of once-daily dosing due to long half-life in infants 1, 3

• Miconazole oral gel: 15 mg every 8 hours 1, 5

  • Higher clinical cure rates (85.1%) compared to nystatin gels (42.8-48.5%) 5
  • Note: Concerns exist regarding potential development of triazole resistance 1

Administration Tips

• For nystatin: Retain medication in mouth as long as possible before swallowing 2
• For all medications: Continue treatment for at least 48 hours after symptoms resolve 2
• For breastfeeding-associated thrush: Consider simultaneous treatment of mother and infant 1
  • Mother should apply miconazole cream to nipples/areola after each feeding 1

Monitoring and Follow-up

• Take swabs for bacterial and candidal culture from lesional areas, particularly sloughy or crusted areas 6
• If symptoms persist despite appropriate therapy, consider:
  • Evaluating for underlying immunodeficiency 7
  • Switching to an alternative antifungal agent 1, 4

Special Considerations

• If using fluconazole, be aware of potential drug interactions with other medications 6
• For persistent or recurrent cases, evaluate for underlying conditions that may predispose to candidiasis 7
• In premature infants, monitor for potential adverse effects of nystatin such as intestinal damage 1

Treatment Algorithm

1. Start with nystatin oral suspension 1 mL four times daily for 7-14 days 1, 2
2. If no improvement after 3-4 days or if compliance is an issue, switch to fluconazole 3-6 mg/kg once daily for 7 days 1, 4
3. For cases associated with breastfeeding, treat both infant and mother simultaneously 1
4. Continue treatment for at least 48 hours after clinical resolution 2