Best Way to Use Nystatin Swish for Oral Infections
For mild oral candidiasis (thrush), nystatin suspension should be used at a dosage of 4-6 mL (400,000-600,000 units) four times daily for 7-14 days, with the patient instructed to swish the medication in the mouth for as long as possible before swallowing. 1, 2
Proper Administration Technique
- Shake the nystatin suspension well before measuring the dose 2
- Measure 4-6 mL (400,000-600,000 units) using a measuring device 1, 2
- Swish the suspension thoroughly in the mouth, ensuring contact with all affected areas for as long as possible (at least 2 minutes) 1
- After swishing, swallow the medication rather than spitting it out to treat potential esophageal involvement 1
- Repeat this process four times daily, ideally after meals and at bedtime 2
- Continue treatment for the full 7-14 days even if symptoms improve sooner 1, 2
Alternative Formulations
- Nystatin pastilles (200,000 units each) are an alternative option, with 1-2 pastilles dissolved slowly in the mouth four times daily for 7-14 days 1, 2
- Pastilles may achieve higher mycological cure rates than suspension alone and might be preferred when available 3
- For severe or resistant cases, consider combination therapy with both suspension and pastilles for better efficacy 3
Treatment Duration Considerations
- Standard treatment duration is 7-14 days for most cases of oral candidiasis 1, 2
- For resistant or recurrent infections, extending treatment to 4 weeks may improve clinical outcomes 3
- Higher dosage pastilles (400,000 IU) result in significantly better mycological cure rates than lower dosage (200,000 IU) formulations 3
Special Considerations
- For denture-related candidiasis, denture disinfection must accompany antifungal therapy 1, 4
- For moderate to severe oral candidiasis, systemic fluconazole (100-200 mg daily for 7-14 days) is more effective than topical nystatin 1, 5
- For immunocompromised patients (especially HIV/AIDS), systemic therapy with fluconazole is generally more effective than nystatin suspension 5
- For recurrent infections in HIV patients, antiretroviral therapy is strongly recommended to reduce recurrence rates 1, 2
Common Pitfalls and How to Avoid Them
- Poor taste is a common complaint with nystatin suspension, which may reduce compliance - flavored formulations may improve adherence 3
- Gastrointestinal adverse effects may occur - taking with food can help minimize these effects 3
- Inadequate duration of swishing reduces contact time with affected tissues - encourage patients to swish for at least 2 minutes before swallowing 2
- Reinfection is common if underlying risk factors are not addressed (dentures, immunosuppression, etc.) 4
- Nystatin suspension is significantly less effective than systemic fluconazole for treating oral candidiasis in infants and immunocompromised patients - consider fluconazole for these populations 5, 6