What is the recommended dosing for nystatin (Nystatin) for treating candidiasis?

Nystatin Dosing for Candidiasis Treatment

For treating candidiasis, nystatin should be dosed as follows: oral suspension 400,000-600,000 units (4-6 mL) four times daily for adults, 200,000 units (2 mL) four times daily for infants, and topical formulations applied 2-3 times daily for 7-14 days. 1, 2

Oral Candidiasis (Oropharyngeal)

First-line Treatment

• Adults and Children: Nystatin oral suspension 400,000-600,000 units (4-6 mL) four times daily 1, 2

  • Retain in mouth as long as possible before swallowing
  • Continue for at least 48 hours after symptoms resolve 2
  • Treatment duration: 7-14 days 1

• Infants: Nystatin oral suspension 200,000 units (2 mL) four times daily 2

  • Use dropper to place half dose in each side of mouth
  • Avoid feeding for 5-10 minutes after administration
  • For premature/low birth weight infants: 100,000 units (1 mL) four times daily 2

• Alternative: Nystatin pastilles 200,000 units, 1-2 pastilles four times daily for 7-14 days 1

  • Evidence suggests pastilles may be more effective than suspension due to longer contact time 3

For Moderate to Severe Disease

• Consider fluconazole 100-200 mg daily for 7-14 days instead of nystatin 1

Esophageal Candidiasis

• Systemic therapy is required; oral fluconazole 200-400 mg daily for 14-21 days is preferred 1
• Nystatin is not recommended as primary therapy for esophageal candidiasis 1

Cutaneous Candidiasis

• Apply nystatin cream/ointment to affected area 2-3 times daily for 14 days or until 7 days after clinical resolution 4
• For diaper dermatitis or intertriginous infections: nystatin with zinc oxide ointment 2-3 times daily 4

Vaginal Candidiasis

• Nystatin 100,000-unit vaginal tablets, one tablet daily for 14 days 1
• For recurrent vulvovaginal candidiasis, monthly 14-day courses of vaginal nystatin may be effective, particularly for C. glabrata infections 5

Special Populations

Neonates

• For prophylaxis in high-risk nurseries (>10% invasive candidiasis rate):
  • Oral nystatin 100,000 units three times daily for 6 weeks in neonates <1500g 1
  • Alternative to fluconazole when availability or resistance is an issue 1

Immunocompromised Patients

• For HIV patients with oropharyngeal candidiasis: same dosing as above, but may require longer treatment courses 1, 4
• Note: For systemic or invasive candidiasis in immunocompromised patients, nystatin is not recommended; systemic antifungals are required 6

Administration Tips

• For oral suspension: swish in mouth as long as possible before swallowing 2
• For topical applications: clean and dry area thoroughly before application 4
• For denture-related candidiasis: disinfection of dentures in addition to antifungal therapy 1

Treatment Duration

• Continue treatment for at least 48 hours after symptoms resolve 2
• For oropharyngeal candidiasis: 7-14 days 1
• For cutaneous candidiasis: 14 days or until 7 days after clinical resolution 4

Monitoring

• Evaluate response within 7 days of starting treatment 4
• If no improvement or worsening occurs, consider alternative antifungal agents 4

Common Side Effects

• Poor taste and gastrointestinal reactions are most common 7
• Generally well-tolerated compared to systemic antifungals 7

Nystatin is most effective for localized Candida infections and should be administered for an adequate duration to ensure complete eradication of the infection. For systemic or invasive candidiasis, other antifungal agents such as fluconazole or echinocandins are preferred 1.