A 12 month old boy is brought to the clinic by his mum because he is refusing to eat and cries more than usual. She is concerned that his ear infection, for which he is receiving antibiotics, has developed into something more severe. Upon exam, the NP notes white patches on the boy's tongue and gums, accompanied by inflamed red areas. Which of the following should be considered as part of his plan of care?

A. Amphotericin B: Amphotericin B is a systemic antifungal reserved for severe or life-threatening fungal infections such as systemic candidiasis or cryptococcal meningitis. It carries significant risks including nephrotoxicity, electrolyte disturbances, and infusion reactions. The infant’s has localized oral candidiasis following antibiotic use, which doesn’t t require aggressive systemic therapy. B. Ketoconazole (Nizoral): Ketoconazole is an azole antifungal that acts by inhibiting fungal ergosterol synthesis in the cell membrane. Although it can treat certain fungal infections, its systemic use is limited due to the risk of hepatotoxicity and multiple drug interactions. In pediatric patients with uncomplicated oral thrush, systemic azoles are generally avoided. C. Nystatin: Nystatin is a polyene antifungal commonly used as the first-line treatment for oral candidiasis in infants. It binds to ergosterol in the fungal cell membrane, creating pores that lead to leakage of intracellular contents and fungal cell death. Antibiotic therapy can disrupt normal oral bacterial flora, allowing Candida species to proliferate, which explains the white plaques and inflamed mucosa observed in this child. D. Itraconazole (Sporanox): Itraconazole is a systemic triazole antifungal that interferes with ergosterol synthesis and is used for more invasive fungal infections such as histoplasmosis, blastomycosis, or refractory mucocutaneous candidiasis. It is not typically used as an initial treatment for simple oral thrush in infants.