From the Guidelines
For a 7-month-old infant with oral candidiasis (thrush), the recommended treatment is nystatin suspension or pastilles four times daily 1. The treatment should be applied directly to the affected areas in the mouth, and it's essential to continue treatment for 7-14 days or until symptoms resolve. It's crucial to note that the provided evidence 1 does not specifically mention the treatment for a 7-month-old infant, but it does provide guidance for nongenital mucocutaneous candidiasis, which includes oropharyngeal candidiasis. Some key points to consider when treating thrush in infants include:
- Applying the medication after feedings to minimize disruption to the infant's feeding schedule
- Using a clean finger or cotton swab to apply the medication directly to the white patches in the infant's mouth
- Continuing treatment for 48 hours after symptoms resolve to prevent recurrence
- Sterilizing pacifiers, bottle nipples, and teething toys daily during treatment to prevent reinfection
- Considering simultaneous treatment of the mother's nipples with an antifungal cream if the infant is breastfeeding, as this can help prevent reinfection 1. If symptoms worsen or don't improve after a few days of treatment, it's essential to consult a pediatrician promptly for further evaluation and guidance.
From the FDA Drug Label
Oropharyngeal candidiasis: The recommended dosage of fluconazole tablets for oropharyngeal candidiasis in children is 6 mg/kg on the first day, followed by 3 mg/kg once daily. Treatment should be administered for at least 2 weeks to decrease the likelihood of relapse
Dosage and Administration in Children: The following dose equivalency scheme should generally provide equivalent exposure in pediatric and adult patients:
- 6 mg/kg 200 mg Experience with fluconazole in neonates is limited to pharmacokinetic studies in premature newborns. Although the efficacy of fluconazole has not been established in infants less than 6 months of age, a small number of patients (29) ranging in age from 1 day to 6 months have been treated safely with fluconazole.
The recommended treatment for oral candidiasis (thrush) in a 7-month-old infant is 6 mg/kg on the first day, followed by 3 mg/kg once daily for at least 2 weeks. However, it is essential to note that the efficacy of fluconazole in infants less than 6 months of age has not been established, but a small number of patients in this age group have been treated safely with fluconazole 2.
From the Research
Treatment Options for Oral Candidiasis in Infants
The treatment for oral candidiasis (thrush) in a 7-month-old infant can be approached with various antifungal medications.
- Fluconazole has been shown to be effective in treating oral candidiasis in infants, with a clinical cure rate of 100% in one study 3.
- Nystatin is another option, although it has been associated with frequent recurrences and difficulty in administration 3.
- Miconazole gel has also been found to be effective in treating oropharyngeal candidiasis in immunocompetent infants, with a clinical cure rate of 96.9% by Day 8 of treatment 4.
Comparison of Treatment Options
Studies have compared the efficacy of different antifungal medications in treating oral candidiasis in infants.
- A study found that fluconazole was superior to nystatin in treating oral thrush in otherwise healthy infants, with a clinical cure rate of 100% compared to 32% for nystatin 3.
- Another study found that miconazole gel was significantly superior to nystatin suspension in treating oropharyngeal candidiasis in immunocompetent infants, with a clinical cure rate of 96.9% compared to 37.6% for nystatin 4.
- Fluconazole suspension has also been found to be more effective than nystatin in treating thrush in immunocompromised children, with a clinical cure rate of 91% compared to 51% for nystatin 5.
Prophylactic Use of Antifungal Medications
Prophylactic use of antifungal medications, such as oral nystatin, can help prevent invasive candidiasis in high-risk infants.
- A study found that prophylactic oral nystatin significantly reduced the incidence of invasive candidiasis in extremely low-birth-weight and very low-birth-weight infants 6.
Current and New Antifungal Drugs
Recent studies have reviewed the therapeutic tools available for oral candidiasis, including current and new antifungal drugs.
- Nystatin and miconazole are the most commonly used topical antifungal drugs, but they may require a long time to eradicate the infection 7.
- Oral fluconazole is effective in treating oral candidiasis that does not respond to topical treatment, and other systemic treatment alternatives are available for recalcitrant infections 7.