What is the prescription for nystatin and zinc oxide for fungal skin infections?

Nystatin and Zinc Oxide Prescription for Fungal Skin Infections

For fungal skin infections, nystatin and zinc oxide ointment should be applied topically to the affected area 2-3 times daily for 14 days or until 7 days after clinical resolution. 1, 2

Formulation and Application

• Prescription Details:
  • Nystatin 100,000 units/g with Zinc Oxide 20% ointment
  • Apply to affected area 2-3 times daily
  • Continue for 14 days or until 7 days after clinical resolution
  • Dispense: 30g tube
  • Refills: 1

Mechanism and Rationale

Nystatin is an effective antifungal agent that binds to ergosterol in fungal cell membranes, creating pores that lead to cell death. The addition of zinc oxide provides protective barrier properties that:

• Reduces moisture in the affected area
• Protects skin from irritation
• May enhance the antifungal efficacy of nystatin 3
• Helps prevent maceration of skin, particularly in occluded areas 3

Clinical Evidence

The Infectious Diseases Society of America guidelines recommend nystatin as an effective option for treating Candida infections, particularly for resistant species like C. glabrata 1. Research has demonstrated that the combination of nystatin with zinc oxide does not decrease the antifungal efficacy of nystatin, and zinc oxide provides additional protection against skin maceration 3.

Patient Instructions

• Keep the affected area clean and dry
• Apply a thin layer of the medication after gentle cleansing with mild soap-free cleanser
• Thoroughly dry the area before application
• For intertrigo (skin fold infections), consider using absorptive powders like cornstarch between applications 2
• Wear light, non-constricting, absorbent cotton clothing to reduce friction and moisture 2

Monitoring and Follow-up

• Evaluate response within 7 days of starting treatment
• If no improvement or worsening occurs despite appropriate therapy, consider:
  1. Alternative antifungal agents (topical azoles like clotrimazole or miconazole)
  2. Oral antifungal therapy for extensive or resistant infections
  3. Evaluation for secondary bacterial infection

Special Considerations

• For severe or extensive infections, consider adding oral fluconazole 150 mg every 72 hours for 2-3 doses 1
• For recurrent infections, consider maintenance therapy with weekly fluconazole for 6 months 1
• For intertrigo in skin folds, additional barrier protection with petroleum jelly may be beneficial 2

Common Pitfalls to Avoid

1. Insufficient treatment duration: Treatment should continue for at least 7 days after clinical resolution to prevent recurrence 2
2. Inadequate drying: Failure to thoroughly dry the affected area before application reduces efficacy
3. Ignoring underlying conditions: Managing conditions like obesity, diabetes, and immunosuppression is crucial for successful treatment 2
4. Improper diagnosis: Ensure proper diagnosis before initiating therapy, as symptoms can be similar to other conditions

The combination of nystatin and zinc oxide provides both antifungal activity and barrier protection, making it particularly effective for fungal skin infections in moist areas or skin folds.