From the Guidelines
Nystatin should be administered 4 times daily for the treatment of mild fungal infections, with a recommended dose of 100,000 U/mL suspension, 4-6 mL, or 1-2 pastilles of 200,000 U each, as supported by the Infectious Diseases Society of America guidelines 1.
Recommended Administration Frequency
The frequency of nystatin administration is crucial for effective treatment of fungal infections.
- For oral thrush, the standard regimen is nystatin oral suspension 100,000 units/mL, with 4-6 mL swished in the mouth for several minutes then swallowed or expectorated, four times daily.
- The recommended dose and frequency are based on the guidelines for the management of candidiasis, which suggest that 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 are effective alternatives for mild disease 1.
Importance of Treatment Duration
Treatment should continue until clinical resolution to prevent recurrence, as premature discontinuation may allow surviving fungal cells to repopulate.
- The guidelines recommend treatment for 7-14 days for mild disease, and the frequency of administration should be maintained throughout this period to ensure adequate local concentrations of the antifungal medication 1.
Comparison with Other Studies
While earlier studies, such as the 2000 practice guidelines for the treatment of candidiasis, also recommend nystatin as a treatment option 1, the most recent guidelines from 2016 provide the strongest evidence for the recommended frequency of administration 1.
- The 2016 guidelines supersede earlier recommendations and provide a stronger basis for clinical decision-making, with a focus on high-quality evidence and strong recommendations 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION 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 The recommended frequency of Nystatin administration is:
- Four times daily for infants, children, and adults. This frequency should be continued for at least 48 hours after perioral symptoms have disappeared and cultures demonstrate eradication of Candida albicans 2.
From the Research
Administration Frequency of Nystatin
The recommended frequency of Nystatin administration varies depending on the specific treatment protocol and patient population.
- According to the study 3, administration of nystatin suspension and pastilles in combination for 2 weeks might achieve a higher clinical and mycological cure rate.
- The study 4 administered nystatin oral suspension in doses of 500,000 units four times daily.
- The study 5 used 1 ml of oral nystatin three times a day for prophylaxis in very low birth weight preterm infants.
- The study 6 compared nystatin oral suspension four times a day for 10 days with fluconazole suspension.
- The study 7 used nystatin suspension (6,000 IU/day) for the prevention of fungal infections in patients with leukaemia.
Dosage and Treatment Duration
The dosage and treatment duration of Nystatin also vary depending on the specific treatment protocol and patient population.
- The study 3 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.
- The study 3 also found that treatment with nystatin pastilles for 4 weeks seemed to have better clinical efficacy than treatment for 2 weeks.
- The study 5 continued the administration of nystatin for a six-week study period.
- The study 6 administered nystatin for 10 days, while fluconazole was administered for 7 days.
- The study 7 continued antifungal prophylaxis throughout the hospital stay or the period of neutropenia to a maximum of 42 days.