What is the recommended dosage of nystatin (antifungal medication) suspension for treating oral thrush or intestinal candidiasis?

Nystatin Suspension Dosage for Oral Thrush and Intestinal Candidiasis

For oral thrush (oropharyngeal candidiasis), nystatin suspension should be dosed at 100,000 U/mL, 4-6 mL four times daily for 7-14 days. 1

Oral Thrush Treatment

First-line Treatment Options:

• Nystatin suspension dosing:

  • Adults and children: 100,000 U/mL, 4-6 mL four times daily for 7-14 days 1
  • Continue treatment for at least 48 hours after symptom resolution
  • Swish in mouth and then swallow

• Alternative nystatin formulations:

  • Nystatin pastilles: 200,000 U each, 1-2 pastilles four times daily for 7-14 days 1
  • Note: Pastilles at 400,000 U dosage have shown higher mycological cure rates than 200,000 U dosage 2

Treatment Duration:

• Standard treatment: 7-14 days 1, 3
• Extended treatment for 4 weeks may improve clinical efficacy in resistant cases 2
• Treatment should continue for at least 48 hours after symptom resolution 3

Intestinal Candidiasis Treatment

For intestinal candidiasis, the dosage is typically higher:

• Adults: 500,000-1,000 U three to four times daily
• Children: 100,000-500,000 U four times daily

Special Populations

Neonates:

• Oral nystatin: 100,000 IU every 8 hours for prevention of invasive candidiasis 1
• This regimen has shown reduction in fungal infection but no change in mortality 1

Immunocompromised Patients:

• Systemic antifungal therapy is often preferred over topical agents like nystatin 3
• Fluconazole has demonstrated superior efficacy compared to nystatin in immunocompromised children (91% vs 51% clinical cure rate) 4

Efficacy Considerations

• Nystatin suspension alone has lower efficacy compared to:
  • Nystatin pastilles alone 2
  • Combination of nystatin suspension and pastilles 2
  • Fluconazole in infants, children, and HIV/AIDS patients 2, 5, 4

Administration Tips

• Instruct patients to swish the suspension in the mouth for as long as possible before swallowing
• Administer after meals to prolong contact time with affected tissues
• For denture wearers: remove dentures before using nystatin and clean dentures thoroughly

Common Adverse Effects

• Poor taste (most common complaint)
• Gastrointestinal reactions (nausea, vomiting, diarrhea)
• Generally well-tolerated with minimal systemic absorption

Prevention of Recurrence

• Maintain good oral hygiene
• Remove and clean dentures daily
• Avoid unnecessary antibiotics when possible
• For recurrent cases, consider investigating underlying causes (immunosuppression, diabetes)

Nystatin suspension is an effective topical treatment for mild to moderate oral thrush, but systemic antifungals like fluconazole may be more effective for severe or refractory cases, especially in immunocompromised patients.