Fluconazole suspension is superior to nystatin in terms of efficacy in the treatment of oral thrush in children

Oral candidiasis is a fairly common clinical form of fungal infection in young children and newborns and occurs in 1 to 37% of children. For several decades, a suspension of nystatin has been the only drug for the treatment of this disease. However, previous reports of high efficacy (more than 90%) of nystatin suspension in the treatment of oral thrush have not been confirmed in modern studies and in clinical practice in general. Fluconazole is one of the new antimicrobial agents active against the pathogens of candidiasis and which may present with oral candidiasis. A prospective, open, randomized study was conducted in the United States, the purpose of which was to obtain information on the clinical and microbiological efficacy of a suspension of fluconazole compared to a suspension of nystatin in children aged 1 at 12 months with clinical signs of oral candidiasis.

A total of 47 patients were included in the study - 19 patients in the fluconazole group and 28 in the nystatin group. Patients received a suspension of nystatin (100,000 units / ml) 4 times a day for 10 days or a suspension of fluconazole (10 mg / ml) at a dose of 3 mg / kg once a day for 7 days. At the end of the study, 15 patients remained in the fluconazole group for evaluation, and 21 patients in the control group.

At the end of the 10th day of treatment, the clinical efficacy in the nystatin group was 28.6%, while in the fluconazole group, at the end of the 7th day, the clinical efficacy was 100% (p less than 0.0001). The microbiological efficacy in the fluconazole group was 73.3%, in the nystatin group 5.6% (p less than 0.0001). The number of clinical relapses of the infection on the 28th day after the end of treatment among the 13 patients who continued to be observed in the fluconazole group was 23% (3 patients). Since fluconazole was prescribed in 15 of the 21 patients in the nystatin group because of its ineffectiveness, it was not possible to assess the number of relapses in the nystatin group. Clinical improvement was not associated with the presence of certain risk factors or the presence of concomitant diseases. During the study period, no adverse event was reported in any of the groups.

Thus, in children with oral candidiasis, the suspension of fluconazole exceeds the suspension of nystatin in clinical and microbiological efficacy by 3.5 and 13 times, respectively, and can be considered as the drug of choice for this disease. However, potential problems when using fluconazole can be its relatively high cost and the risk of developing resistance in fungi of the genus Candida.