What are the treatment options for pediatric candidiasis (fungal infection)?

From the Guidelines

For pediatric yeast infections, the most effective treatment approach depends on the location and severity of the infection, with fluconazole being a recommended option for various forms of candidiasis, as indicated by the 2016 update by the Infectious Diseases Society of America 1.

Treatment Approaches

• For diaper rash caused by yeast, applying an over-the-counter antifungal cream containing miconazole or clotrimazole thinly to the affected area 2-3 times daily for 7-10 days is recommended, continuing for 2-3 days after the rash clears to prevent recurrence.
• For oral thrush, nystatin oral suspension is typically prescribed, with the dose based on the child's age and weight, usually 1-2 mL four times daily for infants, applied directly to the affected areas in the mouth using a clean finger or cotton swab.
• For vaginal yeast infections in adolescent girls, miconazole or clotrimazole vaginal creams or suppositories may be used according to package directions.

Prevention and Management

• Prevention measures include keeping the affected area clean and dry, changing diapers frequently, avoiding bubble baths and scented soaps, and having children wear cotton underwear, as yeast thrives in warm, moist environments.
• If symptoms don't improve within a week, the infection worsens, or the child develops fever, consulting a healthcare provider is necessary, as prescription-strength medications may be needed, with fluconazole, 12 mg/kg intravenous or oral daily, being a reasonable alternative in patients who have not been on fluconazole prophylaxis 1.

Considerations for Severe Infections

• For neonates with disseminated candidiasis, AmB deoxycholate, 1 mg/kg daily, is recommended, with a strong recommendation and moderate-quality evidence 1.
• The removal of central venous catheters (CVCs) is strongly recommended for patients with candidemia, as part of the management strategy to prevent further complications 1.

From the FDA Drug Label

Pediatric Studies Oropharyngeal candidiasis: An open-label, comparative study of the efficacy and safety of fluconazole (2 to 3 mg/kg/day) and oral nystatin (400,000 I. U. 4 times daily) in immunocompromised children with oropharyngeal candidiasis was conducted. The use of fluconazole in children with cryptococcal meningitis, Candida esophagitis, or systemic Candida infections is supported by the efficacy shown for these indications in adults and by the results from several small noncomparative pediatric clinical studies Efficacy of fluconazole has not been established in infants less than 6 months of age.

Pediatric yeast infection treatment can be done with fluconazole (PO) for children 6 months to 13 years of age, with a dose of 2 to 3 mg/kg/day for oropharyngeal candidiasis.

• For children under 6 months, efficacy has not been established.
• Nystatin (TOP) can also be used for pediatric patients, with application to candidal lesions two or three times daily until healing is complete 2.
• Fluconazole has shown to be effective in the treatment of oropharyngeal candidiasis in children, with clinical cure at the end of treatment reported for 86% of fluconazole-treated patients 3.

From the Research

Treatment Options for Pediatric Yeast Infections

• Topical therapies such as clotrimazole, nystatin, and miconazole have been shown to be effective in treating cutaneous candidiasis in pediatric patients, with complete cure rates of 73%-100% 4
• Oral fluconazole has been demonstrated to be as effective as topical clotrimazole and is a commercially available option for systemic treatment of cutaneous candidiasis 4
• For invasive fungal infections, combination antifungal therapy has been used, but there is limited data to support its use in pediatric patients, and most experience is in adult patients 5
• Antifungal agents such as itraconazole, miconazole, and fluconazole have been shown to be effective in treating oral candidiasis, with fluconazole having a better effect in reducing the mycological cure rate 6

Administration and Dosing of Antifungal Agents

• Appropriate antifungal selection and optimized dosing are crucial in the prevention and treatment of invasive fungal diseases in pediatric patients 7
• Conventional amphotericin B has been used as a mainstay of antifungal therapy, but its use is limited by dose-limiting nephrotoxicity and infusion-related adverse events 7
• New antifungal classes and agents have been developed, but data to guide optimal dosing in children are limited 7

Comparison of Antifungal Drugs

• Nystatin, clotrimazole, and miconazole have been compared in the treatment of vaginal candidiasis, with miconazole showing a lower relapse rate 8
• A Bayesian network meta-analysis has compared the efficacy of antifungal drugs in the treatment of oral candidiasis, with fluconazole showing a better effect in reducing the mycological cure rate 6