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Oral candidosis: treatment with absorbable and non-absorbable antifungal agents in children
F Dhondt1, J Ninane, K De Beule
1St Norbertus Hospital, Duffel, Belgium.
Insights
Oral candidosis (thrush) is common in infants. Treatment recommendations vary based on infant age and risk factors, with non-absorbable antifungals preferred for neonates and systemic agents for severe cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Mycology
Background:
- Oral candidosis, commonly known as thrush, is a frequent fungal infection in neonates and young children.
- While typically benign in newborns, it can cause distress and, in older children with predisposing factors like immunodeficiency or chemotherapy, may lead to severe systemic complications such as Candida sepsis.
Purpose of the Study:
- To review and clarify treatment strategies for oral candidosis in neonates and children.
- To differentiate therapeutic approaches based on patient age and the presence of risk factors for disseminated disease.
Main Methods:
- Review of current treatment modalities for oral candidosis in pediatric populations.
- Analysis of antifungal agents based on their absorption characteristics (non-absorbable vs. systemically absorbed).
Main Results:
- Non-absorbable antifungals (e.g., nystatin, miconazole) are recommended for neonatal oral candidosis.
- Systemically absorbed agents (e.g., clotrimazole, fluconazole) are indicated for older children with risk factors for dissemination or widespread disease.
- While generally safe, systemic antifungals in premature infants with impaired liver function require careful monitoring for potential hepatotoxicity.
Conclusions:
- Treatment decisions for pediatric oral candidosis should be tailored to the individual patient's age and clinical status.
- Non-absorbable antifungals offer a safe primary treatment for most neonates, while systemic agents are reserved for more severe or disseminated infections.
- Careful consideration of potential drug toxicity is necessary, particularly with systemically absorbed antifungals in vulnerable infant populations.
Abstract:
Oral candidosis in neonates and children is a common infection which occurs often during the first few months after birth, but occasionally also in older children with certain predisposing factors. In neonates, oral candidosis is usually benign, although the symptoms of such an acute infection can be disturbing to both the patient and the parents. In older children developing oral candidosis, specific predisposing factors may be present (e.g. immunodeficiency, chemotherapy, etc.). In such cases, the infection may constitute a source for further dissemination, leading to occasionally fatal Candida sepsis or to widespread chronic mucocutaneous candidosis. Treatment modalities to date include drugs with limited or no absorption from the gastrointestinal tract (e.g. nystatin and miconazole) and agents that are absorbed, combining local effect with systemic therapy (e.g. clotrimazole, ketoconazole, itraconazole and fluconazole). Overall, it appears that treatment of neonatal oral candidosis should be performed with non-absorbable drugs, while the systemically active agents should be used primarily if a risk of dissemination exists or if widespread disease is present. In general, side-effects and toxicity are not major causes of concern with non-absorbed or absorbed antifungals in children with oral candidosis, since treatment is usually of relatively short duration. When the systemically active agents are used in premature infants with sub-optimal liver function, the risk of drug-induced liver toxicity may be increased.