Recommended Dosage of Mycostatin (Nystatin) for Vaginal Use
For vaginal candidiasis, the recommended dosage of Nystatin is one 100,000-unit vaginal tablet daily for 14 days. 1, 2
Treatment Recommendations
- Nystatin is considered an alternative treatment for vaginal yeast infections when azole medications cannot be used 1
- The standard dosage for uncomplicated vaginal candidiasis is 100,000-unit vaginal tablets inserted once daily for 14 days 1, 2
- Topical azole drugs (such as clotrimazole, miconazole) are generally more effective than nystatin for treating vaginal yeast infections and are considered first-line treatments 1
- Oral fluconazole 150mg as a single dose is also recommended as a first-line treatment option for uncomplicated vaginal candidiasis 1
Special Considerations for Different Types of Infections
- For recurrent vulvovaginal candidiasis (RVVC), nystatin vaginal suppositories at 100,000 units daily can be used as a maintenance regimen, particularly when non-albicans Candida species continue to recur 3, 1
- For Candida glabrata infections that are unresponsive to azoles, nystatin intravaginal suppositories 100,000 units daily for 14 days is recommended 2, 4
- Nystatin has shown better efficacy against C. glabrata compared to fluconazole, with mycological cure rates of 64.3% versus 12.5% respectively 4
- For fluconazole-resistant Candida infections, nystatin may be effective when used for initial and 6-month maintenance therapy 4
Treatment Response and Follow-up
- Clinical response to nystatin treatment should be evident within 48-72 hours for vaginal candidiasis 2
- Mycological cure typically occurs within 4-7 days for vaginal infections treated with nystatin 2
- If symptoms persist beyond the recommended treatment duration, reevaluation for possible resistant organisms or alternative diagnoses is warranted 2
Common Pitfalls and Caveats
- Self-diagnosis of yeast vaginitis is unreliable and may lead to inappropriate treatment 2
- Some studies suggest that combining intravaginal nystatin with oral nystatin may improve outcomes by eliminating intestinal Candida reservoirs that could lead to reinfection 5
- Relapse rates may be higher with nystatin compared to some azole medications like miconazole 6
- For women experiencing persistent or recurrent symptoms despite treatment, evaluation for non-albicans Candida species is important, as these may require different treatment approaches 3, 1
- Approximately 10-20% of women normally harbor Candida species in the vagina without symptoms, and identifying Candida in the absence of symptoms should not lead to treatment 1