Nystatin Treatment Regimens for Fungal Infections
For oropharyngeal candidiasis (oral thrush), nystatin suspension should be administered at a dosage of 200,000-400,000 units four times daily for 7-14 days in adults and 1-7 days in children. 1, 2
Oropharyngeal Candidiasis (Oral Thrush) Treatment
- Nystatin suspension: 4-6 mL (400,000-600,000 units) four times daily for 7-14 days 2
- Alternative formulation: 1-2 nystatin pastilles (200,000 units each) four times daily for 7-14 days 2
- Proper administration technique: Patient should swish the suspension in the mouth for at least 2 minutes before swallowing to ensure contact with all affected areas 2
- Continue treatment for the full prescribed duration even if symptoms improve sooner 2
Treatment Efficacy Considerations
- Nystatin pastilles at a dose of 400,000 IU result in significantly higher mycological cure rates than 200,000 IU dosing 3
- Administration of nystatin pastilles alone or in combination with suspension appears more effective than suspension alone 3
- Extended treatment duration of 4 weeks may provide better clinical efficacy than the standard 2-week regimen for persistent infections 3
- For denture-related candidiasis, denture disinfection must accompany antifungal therapy 2
Special Patient Populations
- For infants with oral thrush: Fluconazole suspension (3 mg/kg once daily for 7 days) has shown superior efficacy compared to nystatin suspension in clinical trials 4
- For immunocompromised patients (including HIV/AIDS): Systemic antifungal therapy with fluconazole (100-200 mg daily) may be more appropriate than topical nystatin 2
- For patients with recurrent infections: Fluconazole 100 mg three times weekly is recommended for chronic suppressive therapy 2
Alternative Indications
- Vaginal candidiasis: Nystatin 100,000 units daily for 14 days has shown efficacy, though higher relapse rates compared to azole antifungals 5
- Prophylaxis: Nystatin can be used prophylactically in leukemic patients during chemotherapy 1
Common Adverse Effects
- Poor taste is the most commonly reported adverse effect 3
- Gastrointestinal reactions may occur, particularly with higher doses 3
- Generally well-tolerated with minimal systemic absorption 3
Treatment Algorithm for Oral Candidiasis
- For mild oral thrush: Nystatin suspension 4-6 mL (400,000-600,000 units) four times daily for 7-14 days 2
- For moderate to severe oral thrush: Oral fluconazole 100-200 mg daily for 7-14 days 2
- For denture-related candidiasis: Nystatin plus denture disinfection 2
- For recurrent infections: Address underlying causes and consider chronic suppressive therapy 2