Clinical inquiries. What is the best treatment for oral thrush in healthy infants?

nystatin oral suspension is a safe firstline therapy; fluconazole is more effective (strength of recommendation [sor]: B, 1 small randomized controlled trial [rCT]) but has not been approved by the Food and Drug Administration (FDA) for use in immunocompetent infants. Miconazole oral gel is also more effective than nystatin suspension, but is not commercially available in the united states (sor: B, one small rCT). Gentian violet may be effective, but it stains skin and clothes and is associated with mucosal ulceration (sor: B, 1 small retrospective cohort study).