Can nystatin and gentamicin (antibiotic) be used together?

Nystatin and Gentamicin Compatibility in Clinical Use

Yes, nystatin and gentamicin can be safely used together as they have different mechanisms of action, target different types of pathogens, and do not have significant drug interactions. 1

Compatibility and Rationale

• Nystatin is an antifungal agent that targets fungi (particularly Candida species), while gentamicin is an aminoglycoside antibiotic that targets gram-negative and some gram-positive bacteria 2
• The combination has been successfully used in clinical practice for prophylaxis against infections in immunocompromised patients 1
• No antagonistic effects have been observed between these medications when used concurrently 3

Clinical Applications

• The combination has been studied and used in several clinical scenarios:
  • Prophylaxis in patients with acute leukemia undergoing chemotherapy 1
  • Prevention of infections in liver transplant recipients 4
  • Treatment of burn wound infections 3

Effectiveness of Combination Therapy

• In a randomized clinical trial, the combination of gentamicin plus nystatin was found to be effective for infection prophylaxis in patients with relapsed acute leukemia 1
• Another study demonstrated that nystatin combined with antimicrobial agents maintained its effectiveness against Candida while allowing the antibacterial agents to maintain their activity 3

Dosing Considerations

• When gentamicin is used for synergy (as in endocarditis treatment), a dose of 3 mg/kg per day divided every 8 hours is recommended 5
• Blood level monitoring is important when using gentamicin:
  • Target peak concentration of 3-4 μg/mL
  • Target trough concentration of <1 μg/mL 5
• Nystatin dosing depends on the formulation and indication (oral, topical, etc.) 5

Special Considerations

• Renal function should be monitored when using gentamicin due to its potential nephrotoxicity 5
• Gentamicin should be used with caution in patients with pre-existing renal impairment 6
• The combination may be particularly useful in immunocompromised patients who are at risk for both bacterial and fungal infections 2

Common Pitfalls to Avoid

• Failing to monitor gentamicin serum concentrations, which can lead to toxicity or subtherapeutic levels 6
• Not adjusting gentamicin dosing in patients with renal impairment 5
• Overlooking potential fungal infections when treating bacterial infections in immunocompromised patients 2

In summary, nystatin and gentamicin can be safely and effectively used together, with each medication targeting different types of pathogens. This combination has been successfully employed in various clinical scenarios, particularly for infection prophylaxis in immunocompromised patients.