When should oral nystatin be taken?

When to Take Oral Nystatin

Oral nystatin suspension should be taken 4 times daily after meals, and patients should swish it around the mouth before swallowing to maximize contact time with affected tissues. 1

Dosing Schedule and Administration

• Standard dosing frequency: 4 times daily 1
• Timing: After meals 1
• Administration technique:
  • Swish the suspension thoroughly in the mouth
  • Hold in mouth for as long as possible (30 seconds to 2 minutes)
  • Then swallow (for oropharyngeal and esophageal candidiasis)
  • For infants: Apply directly to affected areas using a clean finger or cotton swab

Specific Formulations and Dosages

• Oropharyngeal candidiasis:

  • Nystatin suspension: 4-6 mL orally 4 times daily 1
  • Nystatin pastilles: 1-2 flavored pastilles (200,000 U each) orally 4-5 times daily 1

• Prophylaxis in neonates:

  • 100,000 units 3 times daily for 6 weeks (for neonates with birth weights <1500g) 1

Treatment Duration

• Oropharyngeal candidiasis: 7-14 days 1, 2
• Esophageal candidiasis: 14-21 days 1
• Neonatal prophylaxis: 6 weeks 1

Clinical Considerations

• Expected response: Improvement typically occurs within 48-72 hours of starting treatment 1
• Complete resolution: Usually within 7-14 days 2
• Monitoring: Assess clinical response within 3-5 days of treatment initiation 2

Special Populations

• Immunocompromised patients:

  • May require longer treatment durations 2
  • May experience more rapid relapses with topical therapy than with systemic agents like fluconazole 2

• Denture wearers:

  • Remove dentures during nystatin application 2
  • Dentures should be thoroughly disinfected in addition to antifungal therapy 2

Potential Pitfalls

• Nystatin is less effective than fluconazole for oropharyngeal candidiasis but remains a viable option for initial episodes 1
• Some commercial nystatin formulations contain sugar, which may be problematic for certain patients 3
• Nystatin is ineffective for treating systemic fungal infections as it is not significantly absorbed from the gastrointestinal tract 1
• Inappropriate use of nystatin for conditions requiring systemic antifungals (like paracoccidioidomycosis) can mask symptoms and delay proper diagnosis 4

By following these administration guidelines, patients can maximize the effectiveness of oral nystatin therapy for treating fungal infections of the mouth and throat.