From the Guidelines
The recommended duration of nystatin treatment for oral thrush is typically 7-14 days. This recommendation is based on the most recent and highest quality study available, which suggests that nystatin suspension (100,000 U/mL) should be administered 4–6 mL 4 times daily, or 1–2 nystatin pastilles (200,000 U each) 4 times daily, for 7–14 days 1.
Key Considerations
- Treatment should continue for at least 48 hours after symptoms have resolved to prevent recurrence.
- Nystatin is usually prescribed as an oral suspension, with adults and children taking 4-6 mL four times daily, while infants use 1-2 mL per side of the mouth four times daily.
- The medication should be swished around the mouth for as long as possible (at least 2 minutes) before swallowing or spitting out.
- For optimal effectiveness, patients should avoid eating or drinking for 30 minutes after administration.
- If symptoms persist beyond two weeks of treatment, patients should seek further medical evaluation as this may indicate either resistant infection or an underlying condition affecting immune function.
Mechanism of Action
Nystatin works by binding to ergosterol in the fungal cell membrane, creating pores that lead to cell death of the Candida organisms causing the infection.
Alternative Treatments
Alternative treatments for oral thrush include clotrimazole troches, 10 mg 5 times daily, or miconazole mucoadhesive buccal 50-mg tablet applied to the mucosal surface over the canine fossa once daily for 7–14 days 1.
Special Considerations
For moderate to severe disease, oral fluconazole, 100–200 mg daily, for 7–14 days is recommended 1. For fluconazole-refractory disease, itraconazole solution, 200 mg once daily, or posaconazole suspension, 400 mg twice daily for 3 days then 400 mg daily, for up to 28 days are recommended 1.
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 treatment 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 treatment duration may vary depending on the individual patient's response to therapy
- It is essential to follow the recommended treatment duration to prevent relapse of the infection.
From the Research
Nystatin Treatment Duration for Oral Thrush
The recommended duration of nystatin treatment for oral thrush varies depending on the study and patient population.
- In a study comparing fluconazole suspension with nystatin, patients received nystatin 400,000 units four times daily for 14 days 3.
- Another study compared fluconazole with nystatin in infants, with nystatin administered four times a day for 10 days 4.
- However, there is no direct evidence from these studies to support a specific duration of nystatin treatment for oral thrush.
Comparison with Other Treatments
Other studies have compared nystatin with different treatments, such as miconazole gel, and found varying durations of treatment:
- A study comparing miconazole gel with nystatin suspension found that treatment duration varied, with nystatin administered four times daily after meals, but the exact duration was not specified 5.
- Another study compared two nystatin oral gels with miconazole oral gel and found that treatment duration varied according to the amount of drug contained in one tube, with nystatin treatment lasting 10-14 days 6.
Key Findings
Key findings from these studies include:
- Fluconazole suspension was found to be more effective than nystatin in treating oral thrush in immunocompromised children 3 and infants 4.
- Miconazole gel was found to be more effective than nystatin suspension in treating oropharyngeal candidiasis in immunocompetent infants 5.
- The duration of nystatin treatment varied across studies, but was generally administered for 10-14 days 3, 4, 6.