Can I apply nystatin (antifungal) cream to a red percutaneous endoscopic gastrostomy (PEG) tube site?

Management of Red PEG Tube Site: Nystatin Cream Application

Nystatin cream should not be applied to a red PEG tube site as it is not the recommended treatment for this condition. 1, 2

Assessment of Red PEG Tube Site

When a PEG tube site appears red, it's important to determine the cause:

1. Normal redness vs. infection:

   • Less than 5mm of redness around the stoma is common and often caused by movement, not infection 1
   • Signs of infection include: increasing erythema, purulent discharge, pain, fever, or induration

2. Common causes of redness:

   • Mechanical irritation from tube movement
   • Peristomal leakage of gastric contents
   • Hypergranulation tissue
   • Fungal or bacterial infection

Recommended Management Approach

For mild redness without signs of infection:

• Clean the site daily with mild soap and water 1
• Ensure the site is thoroughly dried after cleaning
• Apply a Y-compress under the tube to prevent moisture accumulation 1
• Ensure proper positioning of the external fixation plate (allowing 5mm of free movement) 1
• Push the tube 2-3cm inward and pull back gently to prevent buried bumper syndrome 1

For peristomal leakage:

• Apply zinc oxide-based skin protectants to protect the surrounding skin 1
• Consider foam dressings rather than gauze to reduce skin irritation 1
• Consider proton pump inhibitors to decrease gastric acid secretion 1

For hypergranulation tissue:

• Apply high-potency topical corticosteroid cream/ointment directly to the tissue for 7-10 days 2
• Silver nitrate application is a first-line option for chemical cauterization 2
• Ensure proper tube stabilization to minimize movement 2

For suspected infection:

• Take a swab for microbiological examination 1
• Implement antiseptic measures with daily dressing changes under sterile conditions 1
• Treat persistent local infections with appropriate antibiotics after culture results 1
• For fungal infections, use appropriate antifungal medications as directed by culture results

Why Not Nystatin Cream?

1. Nystatin is specifically for fungal infections (Candida), not for general redness 1
2. Using nystatin without confirming a fungal infection may:
   • Delay appropriate treatment
   • Contribute to antifungal resistance
   • Mask symptoms of other conditions requiring different management

When Antifungal Treatment Is Appropriate

If a fungal infection is confirmed by culture:

• Follow specific treatment recommendations from infectious disease guidelines
• For confirmed Candida infections, appropriate antifungal therapy should be used based on culture results 1

Follow-up and Monitoring

• Monitor the site daily for changes in appearance
• If redness worsens, drainage increases, or systemic symptoms develop, seek prompt medical evaluation
• Document response to interventions and adjust treatment plan accordingly

Remember that proper PEG tube site care is essential to prevent complications and maintain tube function. The approach should focus on identifying the specific cause of redness rather than empirically applying medications.