For how long should nystatin (antifungal medication) swish and swallow be ordered for oral candidiasis?

Duration of Nystatin Swish and Swallow for Oral Candidiasis

Nystatin suspension should be used for 7-14 days for the treatment of oral candidiasis. 1

Treatment Recommendations Based on Disease Severity

Mild Oral Candidiasis

• Nystatin suspension dosing: 100,000 U/mL at 4-6 mL four times daily for 7-14 days 1
• Alternative: 1-2 nystatin pastilles (200,000 U each) four times daily for 7-14 days 1

Administration Instructions

• The suspension should be retained in the mouth as long as possible before swallowing 2
• For optimal effectiveness, patients should:
  • Avoid eating or drinking for at least 5-10 minutes after administration 2
  • Divide each dose, placing half in each side of the mouth 2
  • Continue treatment for at least 48 hours after symptoms have resolved 2

Special Populations

• Children: 4-6 mL (400,000-600,000 units) four times daily 2
• Infants: 2 mL (200,000 units) four times daily 2
• Premature/low birth weight infants: 1 mL four times daily 2

Treatment Considerations

Efficacy Considerations

• Nystatin is less effective than fluconazole for oral candidiasis, with clinical cure rates of 52% vs. 87% in HIV-infected patients 3
• For moderate to severe oral candidiasis, oral fluconazole (100-200 mg daily for 7-14 days) may be more appropriate 1
• Nystatin pastilles appear to have better mycological cure rates than suspension alone 4

Treatment Duration Factors

• Treatment should continue for at least 48 hours after perioral symptoms have disappeared and cultures demonstrate eradication of Candida albicans 2
• For denture-related candidiasis, disinfection of the denture in addition to antifungal therapy is recommended 1

Common Pitfalls to Avoid

1. Premature discontinuation: Stopping treatment as soon as symptoms resolve can lead to relapse; continue for the full prescribed duration 5
2. Inadequate contact time: Not keeping the medication in contact with oral tissues long enough reduces efficacy
3. Eating/drinking too soon: Consuming food or beverages shortly after administration can wash away the medication
4. Inadequate denture care: For denture wearers, failing to disinfect dentures can lead to treatment failure 1

Follow-up and Recurrence

• If symptoms persist after 14 days of therapy, consider:
  • Alternative diagnoses
  • Fluconazole-resistant Candida species
  • Need for systemic antifungal therapy 1
• For recurrent infections, chronic suppressive therapy with fluconazole may be considered 1

The 7-14 day treatment duration recommendation for nystatin suspension represents the optimal balance between ensuring complete eradication of the infection while minimizing unnecessary medication exposure.