Nystatin Powder Dosage and Treatment Duration for Fungal Infections
For fungal skin infections, nystatin powder should be applied to affected areas 2-3 times daily until healing is complete. For oral thrush, nystatin suspension should be used at a dose of 4-6 mL (100,000 U/mL) four times daily or 1-2 nystatin pastilles (200,000 U each) 4-5 times daily for 7-14 days. 1, 2
Nystatin for Skin Infections
Dosage and Application
- Apply nystatin powder to affected skin areas 2-3 times daily until healing is complete 1
- For fungal infections of the feet, dust the powder on feet and inside all footwear 1
- Keeping the infected area dry is important for effective treatment 2
- Very moist lesions are best treated with the topical dusting powder rather than creams or ointments 1
Treatment Duration
- Continue application until complete healing occurs 1
- Most uncomplicated skin infections respond within 7-14 days 2
- For intertrigo in skin folds (common in obese and diabetic patients), nystatin powder is particularly effective 2
Special Considerations
- For severe or extensive infections, such as in burn patients, higher concentrations (up to 6,000 units/g) have been used successfully in specialized settings 3
- For paronychia (infection around the nail), drainage is the most important intervention, with nystatin as adjunctive therapy 2
Nystatin for Oral Thrush
Dosage
- Nystatin oral suspension: 4-6 mL of 100,000 U/mL suspension four times daily 2
- Nystatin pastilles: 1-2 pastilles (200,000 U each) 4-5 times daily 2
Treatment Duration
- Standard treatment course is 7-14 days 2
- Continue treatment for at least 48 hours after symptoms resolve to prevent recurrence 2
Efficacy Considerations
- Nystatin is considered effective for mild cases of oral thrush 2
- For moderate to severe oral thrush, systemic agents like fluconazole (100-200 mg daily for 7-14 days) may be more effective 2
- Studies in infants have shown that fluconazole may be superior to nystatin suspension, with clinical cure rates of 100% vs 32% respectively 4
- Similarly, ketoconazole has shown faster and more effective treatment of oral thrush in infants compared to nystatin (100% vs 53% cure rate after one week) 5
Treatment Alternatives and Considerations
For Refractory Cases
- If nystatin fails for oral thrush, consider fluconazole (100 mg/day for 7-14 days) or itraconazole solution (200 mg/day for 7-14 days) 2
- For fluconazole-resistant cases, options include itraconazole solution (200 mg daily), posaconazole suspension, or amphotericin B oral suspension 2
- For resistant skin infections, consider systemic antifungal therapy 2
Special Populations
- Nystatin is safe for use in infants, children, and adults 4, 5
- For denture-related oral candidiasis, disinfection of the denture in addition to antifungal therapy is essential 2
- In immunocompromised patients, longer treatment courses may be necessary 2
Common Pitfalls
- Failure to keep skin dry in cutaneous infections can lead to treatment failure 2
- Inadequate treatment duration is a common cause of recurrence 2
- For oral thrush, not continuing treatment after symptom resolution often leads to relapse 2
- Oropharyngeal fungal cultures are of little benefit as many individuals have asymptomatic colonization 2