Oral thrush, an infection caused by a fungus of the genus Candida, is common in infants during their first weeks of life. It manifests itself as white or yellowish patches in the mouth, resembling curdled milk. These patches usually disappear spontaneously within 3 to 8 weeks. Thrush can sometimes cause a decrease in appetite or even a refusal to eat.
In full-term infants, it seems unlikely that oral thrush that has no significant impact should be treated immediately. To speed up healing and reduce the risk of recurrence, hygiene measures may be useful, despite the absence of comparative evaluation: hygiene of pacifiers and hands of those around them.
When antifungal treatment is desirable to speed healing, especially when thrush interferes with feeding, nystatin (Mycostatin°) in oral suspension to be applied in the mouth is the first choice. Miconazole (Daktarin°) in oral gel seems as effective as nystatin, but it exposes to aspiration, especially in the youngest infants. In the absence of nystatin available, it is an option, only in infants older than 4 to 6 months, and provided that it is applied cautiously. Oral fluconazole (Triflucan° or other) exposes to sometimes serious adverse effects: it does not seem prudent to expose healthy infants to it, given the benignity of oral thrush in them.
In case of ineffectiveness of an antifungal treatment applied well for 14 days, or of very widespread or recurring thrush, particularly in infants over 6 months old, it seems useful to look for immunodeficiency and to carry out microbiological analysis of a sample of the lesions.
If a woman has nipple candidiasis and is breastfeeding an infant with oral thrush, the mother’s treatment is with an azole antifungal such as clotrimazole (Mycohydralin°) applied to the nipple.
• Full text:
“Oral thrush in infants” Rev Prescrire 2024; 44 (490): 601-605. Reserved for subscribers.
