Nystatin Dosing for a 2-Month-Old Infant
For a 2-month-old infant with oral thrush, administer nystatin oral suspension 2 mL (200,000 units) four times daily for 7-14 days, placing one-half of the dose in each side of the mouth using a dropper and avoiding feeding for 5-10 minutes afterward. 1
Standard Dosing Protocol
The FDA-approved dosing for infants is clear and straightforward 1:
- Dose: 2 mL (200,000 units) four times daily
- Administration technique: Use a dropper to place 1 mL (half the dose) in each side of the mouth
- Timing: Avoid feeding for 5-10 minutes after administration to maximize contact time with oral mucosa
- Duration: Continue for at least 48 hours after symptoms resolve and cultures confirm eradication of Candida 1
This aligns with the American Academy of Pediatrics recommendation of nystatin suspension (100,000 units/mL): 1 mL four times daily for 7-14 days for oral candidiasis in infants 2. Since the standard concentration is 100,000 units/mL, 2 mL delivers 200,000 units per dose 1.
Important Clinical Considerations
Treatment duration: The full 7-14 day course should be completed even when symptoms resolve early to prevent recurrence 3. The endpoint should be mycological cure (negative cultures), not just clinical improvement 2.
Administration tips: The suspension should be retained in the mouth as long as possible before swallowing to ensure adequate contact with all affected oral surfaces 3, 1.
Alternative Considerations
While nystatin is the standard first-line therapy, be aware that:
- Fluconazole (3-6 mg/kg once daily for 7 days) is an alternative with superior efficacy in some studies, showing 100% clinical cure versus 32% with nystatin in one trial 4, though nystatin remains the FDA-approved first-line option for routine cases 1
- Miconazole gel (15 mg every 8 hours) shows clinical cure rates of 85.1% compared to nystatin's 42.8-48.5% 2, but is less commonly used in the United States
Common Pitfalls to Avoid
- Inadequate contact time: Feeding immediately after administration reduces efficacy; wait 5-10 minutes 1
- Premature discontinuation: Parents may stop treatment when symptoms improve, leading to recurrence 3
- Breastfeeding-associated thrush: If the mother is breastfeeding, simultaneous treatment of maternal nipples with antifungal cream is necessary to prevent reinfection 2