From the Guidelines
The recommended dose of nystatin mouthwash for treating oral thrush is typically 4-6 mL (100,000 U/mL) swished in the mouth for several minutes and then swallowed or spit out, four times daily. This dosage is based on the most recent and highest quality study available, which is the 2016 update by the Infectious Diseases Society of America 1. The treatment should continue for at least 48 hours after symptoms resolve, usually for a total of 7-14 days. For best results, patients should avoid eating or drinking for 30 minutes after using the medication. The suspension should be shaken well before measuring each dose. Nystatin works by binding to ergosterol in the fungal cell membrane, creating pores that disrupt membrane integrity and lead to cell death. It specifically targets Candida species, the fungi responsible for thrush, while having minimal systemic absorption when used as a mouthwash. Patients with dentures should remove and clean them thoroughly during treatment, as dentures can harbor fungi and lead to reinfection. If symptoms persist beyond two weeks of treatment, patients should seek further medical evaluation.
Some key points to consider when treating oral thrush with nystatin mouthwash include:
- The importance of completing the full treatment course, even if symptoms resolve before the end of the recommended treatment period 1
- The need for good oral hygiene practices, including regular brushing and flossing, to help prevent reinfection 1
- The potential for drug interactions with other medications, although nystatin is generally well-tolerated and has minimal systemic absorption 1
- The recommendation to disinfect dentures and other oral appliances to prevent reinfection 1
It's worth noting that the 2016 update by the Infectious Diseases Society of America provides the most recent and highest quality guidance on the treatment of oral thrush, and should be consulted for further information on treatment options and recommendations 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). 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 mouthwash for treating thrush is:
- Infants: 2 mL (200,000 units) four times daily
- Children and Adults: 4 to 6 mL (400,000 to 600,000 units) four times daily 2
From the Research
Nystatin Mouthwash Dose for Thrush
- The recommended dose of nystatin mouthwash for treating thrush is not explicitly stated in the provided studies, but the dose of nystatin suspension can be used as a reference.
- According to the study 3, nystatin was administered at a dose of 400,000 units four times daily for 14 days.
- Another study 4 mentions nystatin oral suspension four times a day for 10 days, but the dose is not specified.
- Study 5 compares ketoconazole suspension with nystatin, where nystatin was administered at a dose of 100,000 units per ml.
- Study 6 also mentions nystatin suspension at a dose of 100,000 IU four times daily after meals.
Administration and Efficacy
- Nystatin suspension is typically administered four times daily, as seen in studies 3, 4, and 6.
- The efficacy of nystatin in treating thrush varies across studies, with clinical cure rates ranging from 21.2% to 96.5% in different patient populations, as reported in studies 3, 4, and 6.
- It is essential to note that nystatin may not be as effective as other antifungal medications, such as fluconazole or miconazole, in treating thrush, as shown in studies 3, 4, and 6.