Antifungals

Oral fungal infections occur from alterations in oral flora as a result of the extensive use of broad-spectrum antibiotics, steroids, chemotherapy immunosuppression, and inadequate oral hygiene and nutrition. The most common fungal infection found in children is candidiasis. The clinical variations of candidiasis most commonly found in children are pseudomembranous candidiasis, angular cheilitis, erythematous candidiasis and mucocutaneous candidiasis.

Treatment of candidiasis is accomplished through the topical application of nystatin, clotrimazole and amphotericin and systemic administration of ketoconazole, fluconazole, itraconazole when topical treatment is ineffective. When prescribing antifungals, the clinician must closely monitor and re-evaluate the patient’s response every two weeks. If the response is inadequate, the diagnosis, choice of medication and dosage should be reevaluated. The chosen form of administration is dependent on the child’s ability and maturity to follow directions. The drugs are administered until 2 days after symptoms disappear.

Sample perscriptions:

Topical Antifungals

Rx: Nystatin ointment
Disp: 45 gm tube
Sig: Apply locally as directed with a thin coat to the affected area 4-5 times/day

Rx: Nystatin 100,000 units/ml oral suspension
Disp: 300 ml
Sig: Rinse with 1 teaspoon (5 ml) for 2 minutes 4-5 times/day and expectorate.

Rx: Clotrimazole (Mycelex®) 10 mg troches
Disp: 70 troches
Sig: Dissolve 1 troche in mouth 5 times/day until gone

Rx: Ketoconazole (Nizoral®) 2% cream
Disp: 45 gm tube
Sig: Apply locally as directed with a thin coat to the affected area 4-5 times/day.

Systemic Antifungals – The decision to use systemic antifungals are based on diagnostic culture results.

Rx: Ketoconazole (Nizoral®) 200 mg tablets
Disp: 20 tablets
Sig: Take 1 tablet daily

Rx: Fluconazole (Diflucan®) 100 mg tablets
Disp: 22 tablets
Sig: Take 2 tablets day 1, then 1 tablets/day until finished

Angular Cheilitis Treatment

Rx:Iodoquinol and hydrocortisone cream
Disp: 45 gm tube
Sig: Apply locally as directed 3-4 times/day for 10 days to 2 weeks and re-evaluate

Rx: Nystatin and triamcinolone acetonide ointment
Disp: 45 g tube
Sig: Apply locally as directed to affected area 4 times/day for 10 days to 2 weeks and re-evaluate.