Nystatin Treatment Recommendations for Oral Thrush
For oral thrush treatment, nystatin suspension should be administered at a dosage of 4-6 mL (400,000-600,000 units) four times daily for 7-14 days. 1, 2, 3
Dosing Recommendations by Severity
Mild Oral Thrush
- Nystatin suspension (100,000 units/mL): 4-6 mL four times daily for 7-14 days 1, 2
- Alternative: 1-2 nystatin pastilles (200,000 units each) four times daily for 7-14 days 1, 2
- The preparation should be retained in the mouth as long as possible (at least 2 minutes) before swallowing to ensure contact with all affected areas 2, 3
- Continue treatment for at least 48 hours after symptoms have disappeared 3
Moderate to Severe Oral Thrush
- Oral fluconazole 100-200 mg daily for 7-14 days is recommended instead of nystatin 1, 2
- Fluconazole has demonstrated superior efficacy compared to nystatin in multiple studies 4, 5
Special Populations
Infants and Children
- Infants: 2 mL (200,000 units) four times daily 3
- For premature and low birth weight infants: 1 mL four times daily 3
- In infants and young children, use dropper to place one-half of dose in each side of mouth and avoid feeding for 5-10 minutes 3
Immunocompromised Patients
- For HIV-infected patients with recurrent infections, antiretroviral therapy is strongly recommended to reduce recurrence 1, 2
- For chronic suppressive therapy in recurrent infections, fluconazole 100 mg three times weekly is recommended 1, 2
Administration Techniques for Optimal Results
- Swish the suspension thoroughly in the mouth, ensuring contact with all affected areas for as long as possible 2
- After swishing, swallow the medication rather than spitting it out to treat potential esophageal involvement 2
- Continue treatment for the full 7-14 days even if symptoms improve sooner 2
Important Considerations
- For denture-related candidiasis, disinfection of the denture must accompany antifungal therapy 1, 2
- Clinical studies have shown that fluconazole is more effective than nystatin for oral thrush, with clinical cure rates of 91-100% for fluconazole versus 32-51% for nystatin 4, 5
- Miconazole gel has also demonstrated superior efficacy to nystatin suspension in treating oral thrush in infants 6
- Treatment should be continued for at least 48 hours after perioral symptoms have disappeared and cultures demonstrate eradication of Candida albicans 3
Treatment Algorithm
- Assess severity of oral thrush
- For mild cases: Start nystatin suspension 4-6 mL four times daily for 7-14 days 1, 2
- For moderate to severe cases: Use fluconazole 100-200 mg daily for 7-14 days 1, 2
- For fluconazole-refractory disease: Consider itraconazole solution or posaconazole suspension 1
- For recurrent infections: Consider chronic suppressive therapy with fluconazole 1, 2