From the Guidelines
Nystatin is recommended at a dose of 100,000 U/mL, with a dosage of 4–6 mL 4 times daily, or 1–2 nystatin pastilles (200,000 U each) administered 4 times daily for 7–14 days for the treatment of mild oropharyngeal candidiasis. This recommendation is based on the most recent and highest quality study available, which is the 2016 update by the Infectious Diseases Society of America 1.
Key Points
- The dosage and frequency of nystatin can vary depending on the severity of the disease and the patient's response to treatment.
- For mild disease, nystatin suspension or pastilles are recommended as an alternative to clotrimazole troches or miconazole mucoadhesive buccal tablets 1.
- Treatment should continue for 48 hours after symptoms resolve, usually 7-14 days total.
- Patients should maintain good oral hygiene during treatment and avoid alcohol-containing mouthwashes which may exacerbate symptoms.
Considerations
- Nystatin has minimal systemic absorption, making it safe with few side effects beyond occasional mild gastrointestinal upset or local irritation.
- Chronic suppressive therapy is usually unnecessary, but if required, fluconazole at a dose of 100 mg 3 times weekly is recommended 1.
- For HIV-infected patients, antiretroviral therapy is strongly recommended to reduce the incidence of recurrent infections 1.
Administration
- Nystatin suspension should be swished in the mouth for several minutes before swallowing.
- Nystatin pastilles should be administered 4 times daily, allowing them to dissolve in the mouth.
- For infants, the dose is usually 100,000 units (1 mL) four times daily, applied with a clean finger to coat the inside of the mouth.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Infants: 2 mL (200,000 units) four times daily (in infants and young children, use dropper to place one-half of dose in each side of mouth and avoid feeding for 5 to 10 minutes). NOTE: Limited clinical studies in premature and low birth weight infants indicate that 1 mL four times daily is effective. Children and Adults: 4 to 6 mL (400,000 to 600,000 units) four times daily (one-half of dose in each side of mouth). The recommended dose and frequency of Nystatin are:
- Infants: 2 mL (200,000 units) four times daily
- Premature and low birth weight infants: 1 mL (100,000 units) four times daily
- Children and Adults: 4 to 6 mL (400,000 to 600,000 units) four times daily 2
From the Research
Nystatin Dosage and Frequency
- The recommended dose and frequency of Nystatin can vary depending on the specific condition being treated and the population being studied.
- According to a study published in 2016 3, 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 same study found that treatment with Nystatin pastilles for 4 weeks seemed to have better clinical efficacy than treatment for 2 weeks.
- Another study published in 1995 4 used a dose of 400,000 units of Nystatin four times daily for 14 days in immunocompromised children.
- A study published in 1999 5 used a dose of 6,000 IU/day of Nystatin suspension for the prevention of fungal infections in patients with leukemia.
- A study published in 1997 6 used a dose of 50,000 units/kg/day of Nystatin in four divided doses for the prevention of candida infections in children and adolescents undergoing remission induction or consolidation chemotherapy for cancer.
Comparison with Other Antifungal Medications
- Several studies have compared the efficacy of Nystatin with other antifungal medications, such as fluconazole.
- A study published in 2002 7 found that fluconazole was superior to Nystatin suspension for the treatment of oral thrush in otherwise healthy infants.
- Another study published in 1995 4 found that fluconazole suspension was more effective than Nystatin in the treatment of thrush in immunocompromised children.
- A study published in 1999 5 found that fluconazole was more effective than Nystatin in preventing Candida infections in patients with leukemia.
- A study published in 1997 6 found that fluconazole was as safe and effective as Nystatin in controlling yeast colonization and in preventing superficial and invasive candida infections in children and adolescents undergoing intensive chemotherapy for cancer.