What are the instructions for using oral nystatin (antifungal medication) to treat thrush?

Instructions for Oral Nystatin for Thrush

For the treatment of oral thrush (candidiasis), nystatin suspension should be administered at a dosage of 100,000 U/mL, 4-6 mL four times daily for 7-14 days. 1, 2

Administration Technique

• The suspension should be:
  • Swished around the mouth thoroughly
  • Held in the mouth for as long as possible (at least 2 minutes)
  • Then swallowed or spit out (depending on whether treating just oral cavity or also esophageal/GI tract)
  • Administered after meals to maximize contact time with oral tissues

Dosing Considerations

• Adults and children: 4-6 mL (400,000-600,000 units) four times daily 2
• Infants: Typically 1-2 mL per side of the mouth four times daily
• Duration: 7-14 days for uncomplicated oral candidiasis 1, 2
• Continue treatment for at least 48 hours after symptoms resolve to prevent relapse

Additional Measures for Enhanced Efficacy

• For denture-related candidiasis, disinfection of dentures is required in addition to antifungal therapy 1
• Remove and clean dentures daily
• Avoid wearing dentures at night if possible
• Maintain good oral hygiene
• Rinse mouth after using inhaled corticosteroids 2

Monitoring and Follow-up

• Clinical response should be evaluated within 3-5 days of treatment initiation 2
• If no improvement after 5 days, consider alternative treatments

Alternative Treatments for Refractory Cases

If nystatin fails to resolve the infection, consider:

• Fluconazole 100-200 mg daily for 7-14 days (superior efficacy compared to nystatin in several studies) 1, 3, 4
• Clotrimazole troches 10 mg 5 times daily for 7-14 days 1, 2
• For fluconazole-refractory disease, itraconazole solution 200 mg daily 1, 2

Important Caveats

• Nystatin suspension has shown lower efficacy rates compared to azole antifungals in clinical studies 3, 4, 5
• The meta-analysis by 5 found that nystatin pastilles may be more effective than suspension alone
• Common adverse effects include poor taste and gastrointestinal reactions 5
• Nystatin is FDA-approved specifically for the treatment of candidiasis in the oral cavity 6

Special Considerations for Immunocompromised Patients

• Immunocompromised patients may require longer treatment durations 2
• Fluconazole may be more effective than nystatin in immunocompromised children (91% vs 51% clinical cure rate) 3
• For severe or refractory cases in immunocompromised patients, systemic antifungals may be necessary 1