From the Guidelines
Nystatin is recommended as an alternative treatment for mild oropharyngeal candidiasis, with a dosage of 100,000 U/mL, 4-6 mL, 4 times daily, or 1-2 pastilles (200,000 U each) 4 times daily, for 7-14 days 1.
Key Points
- Nystatin is an antifungal medication used to treat fungal infections caused by Candida species.
- For oral thrush, the typical regimen is nystatin oral suspension 100,000 units/mL, with 4-6 mL swished in the mouth for several minutes then swallowed or expectorated four times daily for 7-14 days.
- Nystatin has minimal systemic absorption, making it very safe with few side effects beyond occasional mild gastrointestinal upset or local irritation.
- It's particularly useful for immunocompromised patients, those on antibiotics, and infants with thrush.
Treatment Recommendations
- For mild disease, alternatives to clotrimazole troches include nystatin suspension (100,000 U/mL) 4-6 mL 4 times daily, or 1-2 nystatin pastilles (200,000 U each) 4 times daily, for 7-14 days 1.
- For moderate to severe disease, oral fluconazole, 100-200 mg daily, for 7-14 days is recommended 1.
- For fluconazole-refractory disease, itraconazole solution, 200 mg once daily, or posaconazole suspension, 400 mg twice daily for 3 days then 400 mg daily, for up to 28 days are recommended 1.
Important Considerations
- Chronic suppressive therapy is usually unnecessary, but if required, fluconazole, 100 mg 3 times weekly, is recommended 1.
- For HIV-infected patients, antiretroviral therapy is strongly recommended to reduce the incidence of recurrent infections 1.
- For denture-related candidiasis, disinfection of the denture, in addition to antifungal therapy, is recommended 1.
From the FDA Drug Label
Gastrointestinal absorption of nystatin is insignificant. Most orally administered nystatin is passed unchanged in the stool. Nystatin is both fungistatic and fungicidal in vitro against a wide variety of yeasts and yeast-like fungi. Nystatin Oral Suspension, USP, is indicated for the treatment of candidiasis in the oral cavity.
Nystatin is an antifungal medication that is fungistatic and fungicidal against a variety of yeasts and yeast-like fungi, including Candida albicans. It works by binding to sterols in the cell membrane of susceptible Candida species, resulting in a change in membrane permeability and leakage of intracellular components. The primary use of nystatin is for the treatment of candidiasis in the oral cavity 2 2.
- Key points:
- Gastrointestinal absorption of nystatin is insignificant.
- Nystatin is effective against Candida species.
- Indicated for the treatment of candidiasis in the oral cavity.
From the Research
Nystatin Overview
- Nystatin is a common antifungal agent used topically to treat oral candidiasis, a fungal infection caused by commensal Candida species 3, 4.
- The efficacy of nystatin in treating oral candidiasis has been evaluated in several studies, with varying results 4, 5, 6.
Efficacy of Nystatin
- A systematic review and meta-analysis found that nystatin was equally effective as photodynamic therapy in treating denture stomatitis and reducing Candida species colony-forming units (CFU/mL) from dentures and palatal surfaces 3.
- Another study found that nystatin pastille was significantly superior to placebo in treating denture stomatitis, but nystatin suspension was not superior to fluconazole in treating oral candidiasis in infants, children, or HIV/AIDS patients 4.
- A comparison of fluconazole and nystatin oral suspensions for treating oral candidiasis in infants found that fluconazole was superior to nystatin, with a clinical cure rate of 100% compared to 32% for nystatin 5.
- A study evaluating the efficacy of fluconazole versus nystatin in treating oral candidosis found that fluconazole was more effective, with 87% of patients showing improvement or cure after 7 days of treatment, compared to 80% for nystatin 6.
Safety and Administration
- Nystatin has been found to be safe and well-tolerated, with common adverse effects including poor taste and gastrointestinal reactions 4, 7.
- The optimal dosage and duration of nystatin treatment vary, with some studies suggesting that higher doses and longer treatment durations may be more effective 4, 7.
- Nystatin tablets have been found to be better accepted by patients than suspensions, particularly at higher dose levels 7.