Oral Nystatin Dosing for a 2-Year-Old
For a 2-year-old child with oral candidiasis (thrush), the recommended dose is 4-6 mL (400,000-600,000 units) of nystatin oral suspension four times daily, with one-half of the dose placed in each side of the mouth, retained as long as possible before swallowing, and continued for at least 48 hours after symptoms resolve. 1
Standard Treatment Dosing
- Children aged 2 years receive the adult dosing regimen: 4-6 mL (400,000-600,000 units) four times daily 1
- The medication should be retained in the mouth as long as possible before swallowing to maximize contact with affected mucosa 1
- Treatment duration is typically 7-14 days for uncomplicated disease 2, 3
- Continue treatment for at least 48 hours after symptoms disappear and cultures demonstrate eradication of Candida albicans 1
Important Clinical Considerations
When Nystatin is Appropriate
- Nystatin is recommended for mild oropharyngeal candidiasis as first-line therapy alongside clotrimazole troches 2
- Consider nystatin when fluconazole is not available or when systemic azole therapy is contraindicated 3
- Nystatin is particularly useful in patients with contraindications to systemic azoles 3
When to Consider Alternative Therapy
- For moderate to severe disease, oral fluconazole 100-200 mg (3 mg/kg) daily for 7-14 days is superior and represents the preferred treatment 2
- A small comparative study demonstrated fluconazole achieved 100% clinical cure versus only 32% with nystatin in infants with oral thrush 4
- Nystatin treatment is associated with frequent recurrences compared to fluconazole 4
Administration Technique
- Place one-half of the dose in each side of the mouth 1
- Avoid feeding for 5-10 minutes after administration to maximize mucosal contact 1
- The suspension should coat the affected areas thoroughly before swallowing 1
Common Pitfalls to Avoid
- Do not discontinue treatment prematurely when symptoms improve; continue for at least 48 hours after clinical resolution 1
- Hypersensitivity reactions are rare but possible; monitor for cutaneous reactions 3
- Nystatin may be ineffective in patients with gastrointestinal dysfunction or feeding intolerance 3
Special Population Note
While your question concerns a 2-year-old, it's worth noting that infants receive a lower dose: 2 mL (200,000 units) four times daily 1. The 2-year-old receives the higher pediatric/adult dosing regimen.