Is Nystatin effective for treating vaginal yeast infections?

Nystatin for Vaginal Yeast Infection

Topically applied azole drugs are more effective than nystatin for treating vaginal yeast infections. 1

Efficacy of Nystatin vs. Other Treatments

• Nystatin vaginal tablets (100,000-unit) are included in treatment guidelines for vulvovaginal candidiasis (VVC), but require a longer treatment duration (14 days) compared to most azole medications 1
• Azole medications (both topical and oral) demonstrate superior efficacy with 80-90% relief of symptoms and negative cultures among patients who complete therapy 1
• Nystatin has higher relapse rates compared to azole medications like miconazole when used for vaginal candidiasis 2
• The FDA label specifically states that Nystatin Cream is not indicated for intravaginal use 3

Treatment Algorithm for Vaginal Yeast Infections

First-line treatments (preferred options):

• Topical azole medications (intravaginal formulations):
  • Clotrimazole 1% cream for 7-14 days or vaginal tablets (100mg for 7 days or 500mg as single dose) 1
  • Miconazole 2% cream for 7 days or vaginal suppositories (200mg for 3 days or 100mg for 7 days) 1
  • Other azoles: butoconazole, terconazole, tioconazole (various formulations and durations) 1
• Oral azole medication:
  • Fluconazole 150mg oral tablet as a single dose 1

Alternative treatment (when azoles cannot be used):

• Nystatin 100,000-unit vaginal tablet, one tablet for 14 days 1
• Consider nystatin for cases involving Candida glabrata or fluconazole-resistant Candida species 4

Special Considerations

• Non-albicans VVC: While C. albicans is the most common cause, non-albicans species (particularly C. glabrata) may require different treatment approaches 1

  • Nystatin may be effective for treating RVVC caused by C. glabrata or fluconazole-resistant Candida with 64.3% mycological cure rate for C. glabrata compared to only 12.5% with fluconazole 4

• Recurrent VVC (RVVC): For women experiencing ≥4 episodes within 12 months 1:

  • Initial induction therapy followed by maintenance therapy for at least 6 months
  • Nystatin vaginal suppositories may be considered as a maintenance regimen if non-albicans Candida continues to recur 1

• Complicated VVC (severe symptoms, immunocompromised host, or non-albicans species):

  • Requires longer duration of therapy (10-14 days) 1
  • Azoles remain first-line, but nystatin may be considered for azole-resistant cases 4

Common Pitfalls and Caveats

• Self-medication with over-the-counter preparations should only be advised for women previously diagnosed with VVC who experience recurrence of the same symptoms 1
• Any woman whose symptoms persist after using OTC preparations or who experiences symptom recurrence within 2 months should seek medical care 1
• Identifying Candida in the absence of symptoms should not lead to treatment, as approximately 10-20% of women normally harbor Candida species in the vagina 1
• Oil-based creams and suppositories may weaken latex condoms and diaphragms 1
• Nystatin cream is specifically not indicated for intravaginal use according to FDA labeling 3

In summary, while nystatin is included in treatment guidelines for VVC, it is not a first-line option due to lower efficacy compared to azole medications and longer required treatment duration. However, it may have a role in treating specific cases involving non-albicans species or azole-resistant infections.