What is the recommended dose of nystatin (antifungal medication) for oral thrush in a 7-month-old infant?

From the Guidelines

For a 7-month-old infant with oral thrush, the recommended nystatin dose is 4–6 mL of oral suspension at a concentration of 100,000 U/mL, administered 4 times daily, as stated in the clinical practice guidelines for the management of candidiasis: 2009 update by the infectious diseases society of america 1.

Key Considerations

• The treatment should be continued for 7–14 days, as recommended by the guidelines 1.
• The medication should be applied using a clean finger or cotton swab, coating the affected areas inside the cheeks, gums, and tongue.
• It is essential to shake the bottle well before each use and not rinse the baby's mouth afterward to maximize contact time with the affected tissues.
• Nystatin works by binding to ergosterol in the fungal cell membrane, creating pores that lead to cell death of the Candida yeast causing the infection.
• If symptoms don't improve within 3-5 days, or if the infant has difficulty feeding or appears in pain, it is crucial to consult a pediatrician as an alternative treatment may be needed.

Additional Recommendations

• Good hygiene practices, including sterilizing pacifiers and bottle nipples, can help prevent reinfection.
• The guidelines also recommend fluconazole as an alternative treatment option for moderate to severe disease, at a dosage of 100–200 mg (3 mg/kg) daily for 7–14 days 1.
• However, for a 7-month-old infant, nystatin suspension is a more suitable option, as it is specifically recommended for mild disease and is easier to administer in infants 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Infants: 2 mL (200,000 units) four times daily (in infants and young children, use dropper to place one-half of dose in each side of mouth and avoid feeding for 5 to 10 minutes).

• The recommended dose of nystatin for oral thrush in a 7-month-old infant is 2 mL (200,000 units) four times daily.
• It is advised to use a dropper to place one-half of the dose in each side of the mouth and avoid feeding for 5 to 10 minutes 2.

From the Research

Nystatin Dosage for Oral Thrush in Infants

• The recommended dose of nystatin for oral thrush in infants is not explicitly stated in the provided studies, but the dosage used in the studies can be referenced.
• In the study 3, nystatin oral suspension was administered four times a day for 10 days.
• In the study 4, oral nystatin was administered three times a day, but the duration of treatment and dosage are not specified.
• In the study 5, two commercial oral nystatin gels were used, with treatment durations of 10 days and 14 days, but the exact dosage is not provided.
• In the study 6, nystatin was administered at a dose of 400,000 units four times daily for 14 days.
• In the study 7, nystatin suspension was administered at a dose of 100,000 IU four times daily after meals, but the exact duration of treatment is not specified.

Efficacy of Nystatin in Treating Oral Thrush

• The efficacy of nystatin in treating oral thrush in infants varies across the studies, with clinical cure rates ranging from 21.2% to 51% 3, 6, 7.
• In comparison, other antifungal medications such as fluconazole and miconazole have shown higher clinical cure rates in treating oral thrush in infants 3, 6, 7.

Administration and Safety

• Nystatin is generally well-tolerated in infants, with few reported side effects 6, 7.
• However, the administration of nystatin can be challenging, particularly in young infants, due to the frequency of dosing and the potential for difficulty in swallowing the suspension 3.