Recommended Duration of Nystatin Treatment for Yeast Infections
The recommended duration of nystatin treatment for yeast infections is 7-14 days for most mucocutaneous candidiasis, with treatment continuing for at least 48 hours after symptoms have resolved and cultures demonstrate eradication of Candida. 1, 2
Duration by Infection Type
Oral Candidiasis (Thrush)
- 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
- Continue treatment for at least 48 hours after perioral symptoms have disappeared and cultures demonstrate eradication of Candida albicans 2
Vaginal Candidiasis
- Nystatin 100,000-unit vaginal tablets for 14 days for uncomplicated infections 1
- For recurrent vulvovaginal candidiasis (RVVC), monthly 14-day courses of vaginal nystatin may be used as maintenance therapy 3
- For C. glabrata infections unresponsive to azoles, nystatin intravaginal suppositories 100,000 units daily for 14 days is recommended 1
Denture-Related Candidiasis
- Nystatin treatment for 7-14 days, combined with proper denture disinfection 1
- Disinfection of the denture in addition to antifungal therapy is strongly recommended 1
Special Populations
Infants and Children
- Infants: 2 mL (200,000 units) four times daily 2
- Premature and low birth weight infants: 1 mL four times daily 2
- Children: 4-6 mL (400,000-600,000 units) four times daily 2
- For oral thrush in infants, a 7-day course may be sufficient, though fluconazole has shown superior efficacy in some studies 4
Immunocompromised Patients
- Duration may need to be extended in immunocompromised patients 1
- For HIV-infected patients with recurrent oropharyngeal candidiasis, antiretroviral therapy is strongly recommended alongside antifungal treatment 1
Treatment Response and Follow-up
- Clinical response should be evident within 48-72 hours for vaginal candidiasis 1
- Mycological cure typically occurs within 4-7 days for vaginal infections 1
- If symptoms persist beyond the recommended treatment duration, reevaluation for possible resistant organisms or alternative diagnoses is warranted 1
Common Pitfalls and Caveats
- Failure to continue treatment for sufficient time after symptom resolution may lead to recurrence 2
- For recurrent infections, addressing potential reservoirs (such as intestinal colonization) may improve outcomes 5
- Self-diagnosis of yeast vaginitis is unreliable and may lead to inappropriate treatment 1
- Nystatin is generally less effective than fluconazole for systemic or moderate-to-severe infections 1
- For fluconazole-resistant Candida species, particularly C. glabrata, nystatin may be an effective alternative 3
- The preparation should be retained in the mouth as long as possible before swallowing for oral infections 2