From the Guidelines
The recommended treatment for candida stomatitis using nystatin oral suspension is 4-6 ml (400,000-600,000 units) four times daily for adults and children, as stated in the 2016 update by the Infectious Diseases Society of America 1.
Treatment Details
The medication should be swished in the mouth for as long as possible (at least 2 minutes) before swallowing or spitting out.
- Treatment typically continues for 7-14 days and should extend for at least 48 hours after symptoms resolve to prevent recurrence.
- For infants and young children, 1-2 ml can be applied to each side of the mouth using a cotton swab or finger.
- Nystatin works as a topical antifungal by binding to ergosterol in the fungal cell membrane, creating pores that lead to cell death.
Administration and Precautions
- The suspension should be used after meals and at bedtime for maximum contact time with affected tissues.
- Patients should avoid eating or drinking for 30 minutes after application.
- If symptoms persist beyond two weeks of treatment, patients should seek further medical evaluation as this may indicate resistance, an underlying condition affecting immune function, or an incorrect diagnosis, as per the guidelines 1.
Disease Severity Considerations
- For moderate to severe disease, oral fluconazole at a dosage of 100–200 mg daily for 7–14 days is recommended 1.
- For fluconazole-refractory disease, alternative treatments such as itraconazole solution or posaconazole suspension are recommended 1.
From the FDA Drug Label
INDICATIONS AND USAGE Nystatin Oral Suspension, USP, is indicated for the treatment of candidiasis in the oral cavity. The recommended treatment for candida stomatitis using nystatin oral suspension is to use it as indicated for the treatment of candidiasis in the oral cavity 2.
- Nystatin Oral Suspension is a suitable option for this condition.
- The drug label directly supports the use of nystatin oral suspension for this purpose.
From the Research
Nystatin Oral Suspension for Candida Stomatitis
- Nystatin oral suspension is a common antifungal agent used to treat oral candidiasis, including candida stomatitis 3, 4.
- The efficacy of nystatin oral suspension in treating candida stomatitis has been evaluated in several studies, with varying results 5, 3, 4.
- A systematic review and meta-analysis of clinical trials found that nystatin suspension was effective in reducing or eliminating Candida organisms during active therapy, but reinfection often occurred after treatment was stopped 3, 4.
- Another study 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.
- The recommended treatment protocol for candida stomatitis using nystatin oral suspension is not well established, but administration of nystatin suspension and pastilles in combination for 2 weeks may achieve a higher clinical and mycological cure rate 4.
- Nystatin pastilles at a dose of 400,000 IU may result in a significantly higher mycological cure rate than that administered at a dose of 200,000 IU, and treatment with nystatin pastilles for 4 weeks may have better clinical efficacy than treatment for 2 weeks 4.
- Compounded preparations with nystatin for oral and oromucosal administration, such as viscous oromucosal suspension, oral/oromucosal hydrogel, and oromucosal gelatine globule, may be useful alternatives to commercial antifungal products 6.
Treatment Outcomes
- Clinical and mycological cure rates have been used as outcome evaluations in studies of nystatin oral suspension for candida stomatitis 3, 4.
- A significant reduction in colony-forming units per milliliters (CFU/mL) of Candida species has been observed with nystatin treatment 3.
- Nystatin and photodynamic therapy have been found to be equally effective for the clinical remission of denture stomatitis and significant reduction of CFU/mL of Candida species from dentures and palatal surfaces of patients 3.