From the Guidelines
The recommended dose of nystatin for oral thrush is 400,000 to 600,000 units (4-6 mL) four times daily, as stated in the clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases society of America 1.
Key Considerations
- The patient should swish the medication in the mouth for as long as possible (at least 2 minutes) before swallowing or spitting it out.
- Treatment usually continues for 7-14 days and should extend at least 48 hours after symptoms resolve.
- For infants and young children, the dose is typically 100,000 units (1 mL) four times daily, applied with a cotton swab or dropper to affected areas.
Mechanism of Action
- Nystatin works by binding to ergosterol in the fungal cell membrane, creating pores that lead to cell death.
Important Reminders
- It's essential to continue the full course of treatment even if symptoms improve quickly to prevent recurrence.
- Patients should avoid eating or drinking for 30 minutes after using nystatin for maximum effectiveness.
- Those with recurrent thrush should address underlying causes such as immunosuppression, antibiotic use, or poorly controlled diabetes.
Alternative Treatments
- Clotrimazole troches, 10 mg 5 times daily, or miconazole mucoadhesive buccal 50-mg tablet applied to the mucosal surface over the canine fossa once daily for 7–14 days are recommended for mild disease 1.
- Oral fluconazole, 100–200 mg daily, for 7–14 days is recommended for moderate to severe disease 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Infants: 2 mL (200,000 units) four times daily (in infants and young children, use dropper to place one-half of dose in each side of mouth and avoid feeding for 5 to 10 minutes). NOTE: Limited clinical studies in premature and low birth weight infants indicate that 1 mL four times daily is effective. Children and Adults: 4 to 6 mL (400,000 to 600,000 units) four times daily (one-half of dose in each side of mouth). The recommended dose of nystatin for oral thrush is:
- Infants: 2 mL (200,000 units) four times daily
- Premature and low birth weight infants: 1 mL four times daily
- Children and Adults: 4 to 6 mL (400,000 to 600,000 units) four times daily 2
From the Research
Nystatin Dosage for Oral Thrush
- The dosage of nystatin for oral thrush is not explicitly stated in the provided studies, but the efficacy of different treatment protocols is discussed 3.
- A study comparing nystatin pastille and suspension found that nystatin pastilles at a dose of 400,000 IU resulted in a significantly higher mycological cure rate than that administered at a dose of 200,000 IU 3.
- The same study suggested that treatment with nystatin pastilles for 4 weeks seemed to have better clinical efficacy than treatment for 2 weeks 3.
- In a study comparing fluconazole and nystatin oral suspensions for the treatment of oral candidiasis in infants, nystatin oral suspension was administered four times a day for 10 days, but the dosage was not specified 4.
Treatment Protocols
- The efficacy of nystatin suspension was compared to fluconazole in treating oral candidiasis in infants, children, or HIV/AIDS patients, and it was found that nystatin suspension was not superior to fluconazole 3.
- A descriptive study found that administration of nystatin suspension and pastilles in combination for 2 weeks might achieve a higher clinical and mycological cure rate, and using the nystatin pastilles alone might have a higher mycological cure rate, when compared with using nystatin suspensions alone 3.
Safety and Adverse Effects
- The most common adverse effects of nystatin are poor taste and gastrointestinal adverse reactions 3.
- A study comparing vaginal nystatin and oral fluconazole for the treatment of recurrent vulvovaginal candidiasis found that both therapies were effective, but nystatin may also be effective for the treatment of RVVC caused by C. glabrata or fluconazole-resistant Candida 5.