Nystatin Swish and Spit Dosage for Adults
For adult patients using nystatin suspension as a swish and spit method, the recommended dosage is 4-6 mL (400,000-600,000 units) four times daily for 7-14 days. 1
Proper Administration Technique
- Nystatin suspension (100,000 units/mL) should be administered at a dosage of 4-6 mL four times daily for mild oral candidiasis 2
- The suspension should be swished thoroughly in the mouth, ensuring contact with all affected areas for as long as possible (at least 2 minutes) 2
- After swishing, the medication should be swallowed rather than spit out to treat potential esophageal involvement 2
- Treatment should continue for at least 48 hours after symptoms have disappeared and cultures demonstrate eradication of Candida albicans 1
Alternative Formulations
- An alternative formulation is nystatin pastilles (troches), which can be used at a dosage of 1-2 pastilles (200,000 units each) four times daily for 7-14 days 3, 2
- Pastilles may be better accepted by some patients and have been shown to be effective in reducing or eliminating Candida organisms during active therapy 4
Treatment Considerations Based on Disease Severity
- For mild oral thrush, nystatin suspension or pastilles are appropriate first-line options 3, 2
- For moderate to severe oral thrush, oral fluconazole (100-200 mg daily for 7-14 days) is more effective and should be considered instead of nystatin 3, 2
- For fluconazole-refractory disease, alternative options include itraconazole solution, posaconazole suspension, voriconazole, or amphotericin B deoxycholate oral suspension 3, 5
Special Considerations
- For denture-related candidiasis, denture disinfection must accompany antifungal therapy 3, 2
- For immunocompromised patients, particularly those with HIV, systemic therapy with fluconazole may be more appropriate than topical nystatin 6
- Studies have shown that fluconazole has higher clinical cure rates (87% vs 52%) and lower relapse rates compared to nystatin in HIV-infected patients 6
- For recurrent infections, fluconazole 100 mg three times weekly is recommended for chronic suppressive therapy 5
Common Pitfalls and Caveats
- Failure to continue treatment for the full recommended duration (7-14 days) even if symptoms improve sooner may lead to recurrence 2
- Not swishing the medication long enough in the mouth reduces contact time with the affected areas and may decrease efficacy 2
- Nystatin is less effective than systemic antifungals like fluconazole for moderate to severe infections or in immunocompromised patients 6
- Reinfection commonly occurs after treatment if underlying predisposing factors are not addressed 4