What is the recommended treatment for thrush in a 12-month-old?

Treatment of Thrush in a 12-Month-Old

Nystatin oral suspension is the recommended first-line treatment for thrush in a 12-month-old, administered as 2 mL (200,000 units) four times daily, with half the dose placed in each side of the mouth.

First-Line Treatment Options

• Nystatin oral suspension should be administered as 2 mL (200,000 units) four times daily for infants, with half of the dose placed in each side of the mouth and avoiding feeding for 5-10 minutes afterward 1
• Treatment should be continued for at least 48 hours after perioral symptoms have disappeared and cultures demonstrate eradication of Candida albicans 1
• For complete mycological cure, continue treatment for at least one week after clinical resolution of symptoms 2

Administration Technique

• Place half of each dose (1 mL) in each side of the mouth using the provided dropper 1
• Avoid feeding the infant for 5-10 minutes after administration to maximize contact time with the oral mucosa 1
• Have the child retain the medication in the mouth as long as possible before swallowing to increase effectiveness 1

Treatment Duration

• Complete the full course of treatment even if symptoms improve quickly to prevent recurrence 2
• Treatment should typically last 7-14 days, with continuation for at least one week after clinical resolution 2
• If no improvement is seen after 2 weeks, reassess the diagnosis or consider alternative therapy 3

Alternative Treatment Options

• Miconazole gel (25 mg four times daily after meals) has shown superior efficacy to nystatin in some studies, with clinical cure rates of 84.7% by day 5 compared to 21.2% for nystatin 4
• Fluconazole oral suspension (3 mg/kg once daily for 7 days) may be considered as an alternative in cases where nystatin is ineffective, with studies showing 100% clinical cure rates compared to 32% for nystatin 5
• However, fluconazole should be used judiciously due to concerns about developing antifungal resistance 6

Prevention of Recurrence and Spread

• Wash hands thoroughly after applying medication to prevent spread of infection 2
• Wash any items that come in contact with the infant's mouth (pacifiers, toys, bottles) in hot water 2
• Check family members for signs of infection and treat if necessary 2
• Identify and treat the source of infection to prevent recurrence 2

Monitoring and Follow-up

• Monitor for clinical improvement within 5-7 days of starting treatment 4
• If symptoms persist beyond 2 weeks despite appropriate therapy, consider alternative diagnoses or resistant infection 3
• Continue treatment for at least 48 hours after symptoms resolve to ensure complete eradication 1