Nystatin Usage and Dosage Guidelines
For mild oral candidiasis (thrush), nystatin suspension 100,000 U/mL, 4-6 mL four times daily OR 1-2 nystatin pastilles (200,000 U each) four times daily for 7-14 days is the recommended treatment regimen. 1
Oral Candidiasis Treatment
Mild Disease
- Nystatin suspension (100,000 U/mL): 4-6 mL four times daily for 7-14 days 1
- Nystatin pastilles (200,000 U each): 1-2 pastilles four times daily for 7-14 days 1
- For children with oral candidiasis, treatment duration is typically shorter (1-7 days) 1
Administration Instructions
- Suspension should be swished in the mouth for as long as possible (at least 2 minutes) before swallowing or spitting out 2
- Pastilles should be allowed to dissolve slowly in the mouth 1
- Treatment should be continued for 48 hours after clinical resolution of symptoms to prevent relapse 2
Special Considerations
- For denture-related candidiasis, disinfection of the denture in addition to antifungal therapy is strongly recommended 1
- Nystatin is preferred for patients who cannot tolerate systemic antifungals or have contraindications to azoles 3
- Sugar-free formulations should be considered, especially for patients with diabetes or those at risk for dental caries 2
Alternative Formulations and Indications
Vaginal Candidiasis
- Nystatin vaginal tablets (100,000 units): 1 tablet intravaginally daily for 14 days 1
- Particularly effective for Candida glabrata infections with a mycological cure rate of 64.3% compared to only 12.5% with fluconazole 4
- Can be effective for fluconazole-resistant Candida species 4
Topical Applications
- For cutaneous candidiasis, apply nystatin cream or ointment to affected areas 2-3 times daily until resolution 1
- For severe burns with angioinvasive fungal infections, nystatin powder at high concentration (6,000 units/g) has shown efficacy 5
Monitoring and Follow-up
- Clinical improvement should be evident within 48-72 hours of initiating therapy 3
- If no improvement is seen after 7 days, consider:
Common Pitfalls and Precautions
- Nystatin is not absorbed systemically and is ineffective for invasive or systemic candidiasis 6
- Some commercial nystatin formulations contain sugar, which may worsen dental caries; sugar-free alternatives should be used when available 2
- Nystatin is less effective than systemic azoles for moderate to severe oral candidiasis 1
- For HIV-infected patients with recurrent oral candidiasis, antiretroviral therapy is strongly recommended in addition to antifungal treatment 1
- Chronic suppressive therapy with nystatin is generally unnecessary unless there are frequent recurrences 1
When to Consider Alternative Agents
- For moderate to severe oral candidiasis, oral fluconazole 100-200 mg daily for 7-14 days is recommended over nystatin 1
- For fluconazole-refractory disease, consider itraconazole solution, posaconazole suspension, or voriconazole 1
- For systemic or invasive candidiasis, nystatin is not appropriate; systemic antifungals are required 1