What is the prescription for nystatin (antifungal medication) swish for oral thrush?

Nystatin Oral Suspension Prescription for Oral Thrush

The standard prescription for nystatin oral suspension for treating oral thrush is 100,000 units (1 mL) four times daily for 7-14 days, with instructions to swish in the mouth for several minutes before swallowing or spitting out. 1, 2, 3

Dosing and Administration Details

Standard Regimen

• Formulation: Nystatin oral suspension 100,000 units/mL
• Dose: 1 mL (100,000 units) per application
• Frequency: 4 times daily
• Duration: 7-14 days
• Administration: Swish in mouth for as long as possible (ideally several minutes) before swallowing or spitting out
• Special instructions: Shake well before using; use after meals and at bedtime for best results

For Infants and Children

• Same concentration (100,000 units/mL)
• For infants: Apply with cotton swab or clean finger to affected areas
• For older children: Same as adult dosing (swish and swallow/spit)

Clinical Considerations

Efficacy Considerations

• Nystatin is effective for mild cases of oral thrush 1, 2
• Clinical cure rates with nystatin are lower than with fluconazole (32-51% vs. 91-100%) 4, 5
• Requires direct contact with affected tissues to be effective

Important Administration Tips

• Patient should avoid eating or drinking for 30 minutes after administration
• For best results, administer after meals and at bedtime
• Complete the full course of treatment even if symptoms improve
• Shake the bottle well before each use to ensure proper suspension

Common Pitfalls to Avoid

1. Inadequate contact time: Nystatin works through direct contact; patients often swallow too quickly
2. Insufficient treatment duration: Stopping therapy when symptoms improve but before completing the full course
3. Improper administration: Not applying to all affected areas of the oral cavity
4. Failure to identify and address underlying causes: Such as dentures, inhaled steroids, or immunosuppression

Alternative Treatments for Refractory Cases

If nystatin is ineffective, consider:

• Mild disease: Clotrimazole troches (10 mg 5 times daily) or miconazole mucoadhesive buccal tablet (50 mg once daily) 1
• Moderate to severe disease: Oral fluconazole (100-200 mg daily for 7-14 days) 1, 2
• Fluconazole-refractory cases: Itraconazole solution (200 mg daily) or posaconazole suspension (400 mg twice daily for 3 days, then 400 mg daily) 1

Special Considerations

For denture-related candidiasis, disinfection of the denture in addition to antifungal therapy is essential 1, 2.

For immunocompromised patients, systemic therapy with fluconazole may be more appropriate as first-line treatment 1, 2, 6.

For patients with recurrent infections, addressing underlying causes and possibly implementing chronic suppressive therapy with fluconazole 100 mg three times weekly may be necessary 1.