What is the treatment and parent education for thrush (oral candidiasis) in infants?

Treatment and Parent Education for Infant Oral Thrush

For mild to moderate oral thrush in infants, nystatin oral suspension (100,000 units/mL) 1 mL four times daily for 7-14 days is the recommended first-line treatment. 1, 2, 3

First-Line Treatment Options

• Nystatin oral suspension (100,000 units/mL): 1 mL four times daily for 7-14 days 1, 2, 3
  • Administration technique: Use dropper to place one-half of dose in each side of mouth and avoid feeding for 5-10 minutes 3
  • Continue treatment for at least 48 hours after symptoms have disappeared 3

Alternative Treatment Options (for resistant or recurrent cases)

• Fluconazole oral suspension: 3-6 mg/kg daily for 7 days 2, 4, 5

  • More effective than nystatin with clinical cure rates of 100% vs 32% in one study 6
  • Once-daily dosing due to longer half-life (55-90 hours) in neonates 2, 4
  • Consider for cases that don't respond to nystatin 1, 2

• Miconazole oral gel: 25 mg four times daily after meals for 7-14 days 2, 7

  • Higher clinical cure rates compared to nystatin (85.1% vs 42.8-48.5%) 8
  • Apply to affected areas of the oral mucosa 2

Parent Education

• Proper medication administration: 1, 3

  • For nystatin: Apply half the dose to each side of the infant's mouth using the provided dropper
  • Avoid feeding for 5-10 minutes after administration
  • Continue treatment for at least 48 hours after symptoms resolve

• For breastfeeding mothers: 2

  • If mother has nipple candidiasis, both mother and infant should be treated simultaneously
  • Mother should apply miconazole cream to nipples/areola after each feeding
  • Sanitize pacifiers, bottle nipples, and toys that go into baby's mouth

• Expected outcomes: 1, 6

  • Improvement typically begins within 2-3 days
  • Complete resolution usually occurs within 7-14 days
  • Follow up if no improvement after 3 days of treatment

• Prevention measures: 1, 2

  • Good oral hygiene practices
  • Proper sterilization of bottles, pacifiers, and toys
  • Proper hand hygiene before handling infant

Special Considerations

• For premature infants with birth weight <1000g in nurseries with high rates of invasive candidiasis (>10%), prophylactic fluconazole (3-6 mg/kg twice weekly for 6 weeks) is recommended 1, 4

• For recurrent or persistent thrush: 1, 2

  • Consider switching to fluconazole if nystatin fails
  • Evaluate for underlying conditions or immunodeficiency
  • Ensure proper medication administration technique

• Monitor for potential adverse effects: 2, 5

  • Nystatin: Generally well-tolerated, may cause mild gastrointestinal upset
  • Fluconazole: Potential for gastrointestinal symptoms (16% vs 4% for topical treatments) 5
  • Miconazole: Generally well-tolerated in infants 7, 8

By following these treatment recommendations and parent education guidelines, most cases of infant oral thrush can be effectively managed with complete resolution of symptoms.