What is the recommended dosage of oral nystatin (antifungal medication) for adults and children?

Recommended Dosage of Oral Nystatin for Adults and Children

For adults, the recommended dosage of oral nystatin suspension is 4-6 mL (400,000-600,000 units) four times daily, while for children it is 4 mL (400,000 units) four times daily, and for infants 2 mL (200,000 units) four times daily. 1

Dosage by Age Group

Adults

• 4-6 mL (400,000-600,000 units) of nystatin suspension four times daily 1, 2
• Alternative: 1-2 nystatin pastilles (200,000 units each) four times daily 2
• Treatment duration: 7-14 days, continuing for at least 48 hours after symptoms resolve 1, 3

Children

• 4 mL (400,000 units) of nystatin suspension four times daily 1
• Treatment duration: 7-14 days 2

Infants

• 2 mL (200,000 units) of nystatin suspension four times daily 1
• For premature and low birth weight infants: 1 mL (100,000 units) four times daily 1
• Treatment duration: 7-14 days 1

Administration Technique

• The suspension should be retained in the mouth as long as possible before swallowing (at least 2 minutes) 2, 1
• For infants and young children, use a dropper to place one-half of the dose in each side of the mouth 1
• Avoid feeding infants for 5-10 minutes after administration 1
• Continue treatment for at least 48 hours after symptoms have disappeared and cultures demonstrate eradication of Candida albicans 1

Special Considerations

Oral Thrush

• For mild oral thrush, nystatin suspension is appropriate as first-line therapy 2
• For moderate to severe oral thrush, fluconazole may be more effective than nystatin 2, 4
• Clinical studies have shown that fluconazole has higher clinical cure rates (91%) compared to nystatin (51%) in immunocompromised children 5

Vaginal Candidiasis

• For vaginal candidiasis, nystatin 100,000-unit vaginal tablets can be used once daily for 14 days 3
• However, studies suggest higher relapse rates with nystatin compared to azole antifungals for vaginal candidiasis 6

Neonatal Candidiasis Prevention

• For prevention of invasive candidiasis in neonates, oral nystatin 1 mL (100,000 IU) every 8 hours can be used 3

Efficacy Considerations

• Nystatin pastilles appear to be more effective than suspension alone in treating oral candidiasis 7
• Combination of nystatin suspension and pastilles may achieve higher cure rates than either formulation alone 7
• Treatment duration of 4 weeks may have better clinical efficacy than 2 weeks for persistent infections 7
• In comparative studies, fluconazole has shown superior efficacy to nystatin for oral candidiasis in both immunocompetent and immunocompromised patients 4, 5, 8

Common Side Effects

• Poor taste is a common complaint with nystatin oral formulations 7
• Gastrointestinal upset may occur 7
• Cutaneous hypersensitivity reactions are rare but possible 3

Remember that while nystatin is effective for many cases of candidiasis, systemic antifungals like fluconazole may be more appropriate for moderate to severe infections, particularly in immunocompromised patients.