What does Nystatin (antifungal medication) oral rinse treat?

From the Guidelines

Nystatin oral rinse is recommended as an alternative treatment for mild oral candidiasis, with a regimen of 100 000 U/mL, 4–6 mL, 4 times daily, for 7–14 days 1. The treatment of oral candidiasis, also known as oral thrush, typically involves antifungal medications, and nystatin is one of the options.

• The dosage and duration of nystatin treatment are crucial for effective management of the infection.
• According to the clinical practice guideline for the management of candidiasis, nystatin suspension is an alternative for mild disease, with a strong recommendation based on moderate-quality evidence 1.
• The recommended regimen for nystatin suspension is 100 000 U/mL, 4–6 mL, 4 times daily, for 7–14 days, which is similar to other antifungal treatments for mild oral candidiasis.
• It is essential to note that nystatin is not the first-line treatment for oral candidiasis, and other options like clotrimazole troches or miconazole mucoadhesive buccal tablets are recommended as the primary treatment 1.
• However, nystatin can be used as an alternative, especially in cases where other treatments are not effective or tolerated.
• Patients should be advised to continue treatment for at least 48 hours after symptoms resolve to prevent recurrence, and denture wearers should remove and soak their dentures in nystatin solution at night.
• Nystatin is generally well-tolerated, with minimal side effects, but patients should be monitored for any adverse reactions, and further medical evaluation should be sought if symptoms persist beyond two weeks of treatment 1.

From the FDA Drug Label

INDICATIONS AND USAGE Nystatin Oral Suspension, USP, is indicated for the treatment of candidiasis in the oral cavity.

Nystatin oral rinse treats candidiasis in the oral cavity.

• The drug is used for oral cavity infections caused by Candida. Key points:
• Treatment: candidiasis in the oral cavity
• Drug: Nystatin Oral Suspension, USP 2

From the Research

Nystatin Oral Rinse Treatment

• Nystatin is a common antifungal agent used to treat oral candidiasis, with studies showing its effectiveness in reducing Candida species and improving clinical outcomes 3, 4.
• A systematic review and meta-analysis found that nystatin pastille was significantly superior to placebo in treating denture stomatitis, while nystatin suspension was not superior to fluconazole in treating oral candidiasis in infants, children, or HIV/AIDS patients 4.
• A study on healthy adults found that nystatin oral rinse significantly reduced salivary Streptococcus mutans and improved periodontal status, with half of the participants being free of salivary C. albicans after using the rinse 5.
• Another study compared the efficacy of fluconazole and nystatin oral suspensions for treating oral candidiasis in infants, finding that fluconazole was superior to nystatin, with a 100% clinical cure rate compared to 32% for nystatin 6.
• The antifungal activity of nystatin has also been compared to other agents, such as capric acid and fluconazole, with nystatin showing the lowest minimum inhibitory concentrations against Candida isolates 7.

Efficacy and Safety

• The efficacy of nystatin for treating oral candidiasis has been shown to depend on the formulation, dosage, and duration of treatment, with nystatin pastilles being more effective than suspensions in some cases 4.
• Nystatin has been found to be safe and well-tolerated, with common adverse effects including poor taste and gastrointestinal reactions 4.
• The use of nystatin in combination with other antifungal agents, such as fluconazole, has shown varying results, with some studies finding synergistic interactions and others finding indifferent or antagonistic interactions 7.

Treatment Protocols

• Nystatin oral rinse has been used in various treatment protocols, including 4 applications per day for 7 days, with 600,000 International Units per application 5.
• The duration of treatment with nystatin has been shown to affect its efficacy, with longer treatment durations (up to 4 weeks) resulting in better clinical outcomes 4.
• The dosage of nystatin has also been found to impact its efficacy, with higher doses (400,000 IU) resulting in higher mycological cure rates than lower doses (200,000 IU) 4.