From the FDA Drug Label
INDICATIONS AND USAGE Nystatin Oral Suspension, USP, is indicated for the treatment of candidiasis in the oral cavity. The FDA drug label does not answer the question.
From the Research
Nystatin can be applied directly to the nipple for treatment of oral thrush in a breastfeeding infant, but it is crucial to follow proper application and precautions to avoid potential risks, as highlighted in a case where miconazole oral gel caused near asphyxiation in a neonate 1. The standard treatment involves applying nystatin oral suspension directly into the infant's mouth (typically 1 mL or 100,000 units four times daily after feedings for 7-14 days). For mothers, applying nystatin cream to the nipples after each feeding can help prevent reinfection, especially if the mother is experiencing nipple pain or has visible signs of infection. Key points to consider:
- The mother should apply a thin layer of nystatin cream to clean, dry nipples after breastfeeding and allow it to remain until the next feeding.
- Before the next feeding, the cream should be gently wiped off.
- This dual treatment approach is important because thrush can be passed back and forth between mother and baby during breastfeeding.
- Nystatin works by binding to sterols in the fungal cell membrane, creating pores that lead to cell death.
- It's generally safe for both mother and infant as it's minimally absorbed systemically.
- If symptoms persist beyond two weeks of treatment, both mother and baby should be reevaluated by a healthcare provider. Recent studies have shown that other antifungal agents, such as fluconazole and miconazole, may be more effective than nystatin in treating oral thrush in infants 2, 3, 4, 5. However, nystatin remains a viable option, especially when considering the potential risks associated with other treatments, as seen with miconazole oral gel 1. It is essential to weigh the benefits and risks of each treatment option and consider the most recent and highest quality evidence when making a decision. In this case, the most recent study 5 suggests that miconazole oral gel may be more effective than nystatin in treating oral thrush in infants, but the potential risks associated with its use must be carefully considered.