Can nystatin be used to treat vaginal candidiasis (vaginal yeast infection)?

From the Guidelines

Nystatin can be used to treat vaginal candidiasis, with a recommended dosage of 100,000-unit vaginal tablet, one tablet for 14 days, as stated in the guidelines by the Centers for Disease Control and Prevention 1.

Treatment Overview

The treatment of vaginal candidiasis typically involves the use of antifungal medications, which can be administered orally or intravaginally. Nystatin is one such medication that can be used to treat vaginal yeast infections.

• The usual dosage of nystatin for vaginal candidiasis is one 100,000-unit suppository or 1 applicatorful of cream per application, inserted into the vagina once or twice daily for 7-14 days.
• It is essential to complete the full course of treatment, even if symptoms improve before finishing, to ensure that the infection is fully cleared.
• Nystatin works by binding to ergosterol in the fungal cell membrane, creating pores that lead to cell death of Candida species.

Efficacy and Safety

While nystatin is effective for uncomplicated yeast infections, it may be less commonly prescribed than other antifungals like miconazole or fluconazole, as noted in the guidelines by the Infectious Diseases Society of America 1.

• Side effects of nystatin are generally mild and may include local irritation or burning.
• For best results, it is recommended to avoid sexual intercourse during treatment or have your partner use a condom, maintain good hygiene, wear cotton underwear, and avoid douching.
• If symptoms persist after treatment or recur frequently, it is essential to consult a healthcare provider, as this might indicate a different infection or underlying condition.

Clinical Practice Guidelines

The clinical practice guidelines for the management of candidiasis, as updated by the Infectious Diseases Society of America in 2016, recommend the use of nystatin for the treatment of vulvovaginal candidiasis, particularly for complicated cases or cases caused by non-albicans species 1.

• The guidelines also recommend that treatment should be individualized based on the severity of symptoms, the presence of underlying medical conditions, and the patient's response to previous treatments.
• In cases of recurrent vulvovaginal candidiasis, maintenance therapy with an azole regimen for at least 6 months may be necessary to prevent recurrence.

From the FDA Drug Label

Nystatin Cream USP is indicated in the treatment of cutaneous or mucocutaneous mycotic infections caused by Candida albicans and other susceptible Candida species. Nystatin Cream USP is not indicated for systemic, oral, intravaginal or ophthalmic use.

• Nystatin cream is not indicated for intravaginal use.
• The FDA drug label explicitly states that nystatin cream is not for vaginal use.
• Therefore, nystatin cream should not be used to treat vaginal candidiasis 2.

From the Research

Treatment Options for Vaginal Candidiasis

• Nystatin can be used to treat vaginal candidiasis, as indicated by studies 3, 4, 5
• The efficacy of nystatin in treating vaginal candidiasis is comparable to other antifungal agents such as fluconazole and clotrimazole 3, 5
• However, some studies suggest that nystatin may not be as effective as azoles in treating recurrent vulvovaginal candidiasis 6

Comparison of Nystatin with Other Antifungal Agents

• A study comparing nystatin, clotrimazole, and miconazole found that nystatin was equivalent to clotrimazole and miconazole in curing vaginal candidiasis, but had a higher relapse rate 5
• Another study found that nystatin was effective in treating RVVC caused by C. glabrata or fluconazole-resistant Candida 3
• In vitro antifungal sensitivity testing found that clotrimazole was more effective than nystatin and fluconazole against Candida species 4

Clinical Considerations

• The choice of antifungal agent for treating vaginal candidiasis may depend on factors such as the severity of the infection, the presence of underlying medical conditions, and the patient's pregnancy status 6, 7
• Antifungal susceptibility testing may be necessary to determine the most effective treatment option for a particular patient 4