From the Guidelines
The recommended duration of nystatin therapy for oral thrush is 7-14 days, as stated in the 2016 clinical practice guideline for the management of candidiasis by the Infectious Diseases Society of America 1.
Key Considerations
- For mild disease, 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 is recommended (strong recommendation; moderate-quality evidence) 1.
- The medication should be swished in the mouth for as long as possible (ideally 1-2 minutes) before swallowing or spitting out.
- Treatment should continue even if symptoms improve before the full course is completed to prevent recurrence.
- Patients should also maintain good oral hygiene, avoid smoking, and control blood sugar if diabetic to support treatment effectiveness.
Dosage and Administration
- For most uncomplicated cases, patients should use nystatin oral suspension 100,000 units/mL, with a dosage of 4-6 mL four times daily.
- For infants and young children, the dose is typically 1-2 mL in each side of the mouth four times daily.
Mechanism of Action
- Nystatin works by binding to ergosterol in the fungal cell membrane, creating pores that lead to cell death.
- The extended duration ensures complete eradication of the Candida organisms, as premature discontinuation often leads to relapse.
Comparison with Other Guidelines
- The 2004 guidelines for treatment of candidiasis also recommend nystatin for 7-14 days, but with a lower level of evidence (B-II) 1.
- However, the 2016 guideline provides stronger evidence and is more recent, making it the preferred recommendation.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... Continue treatment for at least 48 hours after perioral symptoms have disappeared and cultures demonstrate eradication of Candida albicans. The recommended duration of nystatin therapy for oral thrush is to continue treatment for at least 48 hours after symptoms have disappeared and cultures demonstrate eradication of Candida albicans 2.
- Key points:
- Treatment should be continued for a sufficient duration to ensure eradication of the infection
- The duration of treatment is not solely based on the disappearance of symptoms, but also on culture results
- Minimum treatment duration is at least 48 hours after symptoms have resolved and Candida albicans is no longer detected in cultures 2
From the Research
Duration of Nystatin Therapy for Oral Thrush
The recommended duration of nystatin therapy for oral thrush varies depending on the study and patient population.
- In a study comparing fluconazole and nystatin for the treatment of oropharyngeal candidiasis in immunocompromised children, nystatin was administered four times daily for 14 days 3.
- Another study comparing fluconazole and nystatin for the treatment of oral candidiasis in infants used nystatin oral suspension four times a day for 10 days 4.
- However, there is no direct evidence from these studies to support a specific duration of nystatin therapy for oral thrush in general.
Factors Influencing Duration of Therapy
The duration of nystatin therapy may depend on various factors, including:
- Patient population: Immunocompromised patients may require longer treatment durations than immunocompetent patients.
- Severity of infection: More severe infections may require longer treatment durations.
- Response to treatment: Patients who respond quickly to treatment may require shorter treatment durations.
Comparison with Other Antifungal Agents
Studies have compared the efficacy of nystatin with other antifungal agents, such as fluconazole and miconazole.