A 6-year-old asthmatic has the finding shown in the image below on routine examination. Which of the following is the most appropriate pharmacotherapy for the lesions on this patient's oral mucosa?

Question

A 6-year-old asthmatic has the finding shown in the image below on routine examination.  Which of the following is the most appropriate pharmacotherapy for the lesions on this patient's oral mucosa?

Quizplus · Accepted Answer

The thick white patches seen on this patient's tongue are indicative of oral thrush (oropharyngeal candidiasis). Thrush is a common variant of localized infection with Candida fungi. Oral thrush is common in young infants due to immaturity of the newborn immune system. In older children and adults, it is associated with immunosuppression and frequently occurs in patients with HIV infection, diabetes mellitus, and cancer. Asthma patients who take oral or inhaled steroids are also at risk for candidiasis. Systemic antibiotic therapy and dentures are other predisposing factors. In immunocompetent patients, localized candidiasis is treated with topical antifungal medications. Nystatin is a polyene antifungal with a mechanism of action similar to amphotericin B. It binds to ergosterol molecules in the fungal cell membrane, causing pores and leakage of fungal cell contents. Nystatin is not absorbed from the gastrointestinal tract. It is administered as an oral agent ("swish and swallow") for oropharyngeal candidiasis. (Choice A) Acyclovir is an antiviral drug effective against herpes simplex virus (1 and 2) and varicella zoster virus. It is a nucleoside analog that is converted into acyclo-GTP in infected cells, which inhibits viral DNA polymerase. (Choice B) Amphotericin B is a polyene antifungal similar to nystatin used for systemic mycoses. It is administered intravenously and never used for simple mucocutaneous infections due to many toxic side effects. (Choice C) Griseofulvin inhibits fungal cell mitosis at metaphase. It is indicated for the treatment of dermatophytoses, not candidiasis. (Choice E) Penicillins are β-lactam antibiotics that inhibit the formation of peptidoglycan cross-links in bacterial cell walls. (Choice F) Terbinafine is an allylamine antifungal that accumulates in the skin, nails, and adipose tissue. It is used to treat dermatophytosis (onychomycoses), not candidiasis. Educational objective: Nystatin is a polyene antifungal and the drug of choice for oropharyngeal candidiasis in patients without advanced immunodeficiency. It acts by binding to ergosterol in the fungal cell membrane, causing the formation of pores and leakage of fungal cell contents. Nystatin is not absorbed from the gastrointestinal tract and is administered as an oral "swish and swallow" agent.

A 6-Year-Old Asthmatic Has the Finding Shown in the Image