Nystatin Suspension Dosing for Mild Fungal Infection of the Tongue
For mild fungal infection of the tongue, nystatin suspension should be administered at a dose of 4-6 mL (400,000-600,000 units) four times daily for 7-14 days. 1, 2
Dosing Recommendations
- Standard adult dose: 4-6 mL (400,000-600,000 units) four times daily 1
- Administration technique:
- Place half the dose on each side of the mouth
- Retain the suspension in the mouth as long as possible before swallowing
- Avoid eating or drinking for 5-10 minutes after administration
Duration of Treatment
- Continue treatment for 7-14 days 2
- Treatment should extend for at least 48 hours after symptoms have disappeared 1
- Clinical improvement typically occurs within 48-72 hours of starting treatment
Alternative Options for Mild Oral Fungal Infections
If nystatin suspension is not available or tolerated, consider these alternatives:
- Nystatin pastilles: 1-2 pastilles (200,000 units each) 4 times daily for 7-14 days 2
- Clotrimazole troches: 10 mg 5 times daily for 7-14 days 2
Special Considerations
- For denture-related candidiasis: Disinfection of dentures in addition to antifungal therapy is essential 2
- For refractory cases: If no improvement after 7 days, consider:
- Alternative diagnosis
- Resistant Candida species
- Need for systemic therapy with fluconazole 100-200 mg daily for 7-14 days 2
Monitoring
- Assess clinical response within 3-5 days of treatment initiation
- Complete resolution usually occurs within 7-14 days
- If symptoms persist despite appropriate therapy, consider fluconazole-resistant Candida species
Pitfalls to Avoid
- Inadequate duration: Stopping treatment too early can lead to recurrence
- Poor administration technique: Not retaining the suspension in the mouth long enough reduces effectiveness
- Ignoring underlying factors: Dentures, inhaled corticosteroids, and broad-spectrum antibiotics can contribute to oral candidiasis
- Missing resistant species: If no improvement after 7 days, consider fluconazole-resistant species that may require alternative therapy
Nystatin suspension is an effective first-line treatment for mild fungal infections of the tongue, with good clinical evidence supporting its use at the recommended dose and duration.