Nystatin Swish and Spit Dosage 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, with the medication swished in the mouth as long as possible before swallowing. 1, 2
Recommended Dosing Protocol
- Nystatin oral suspension (100,000 units/mL): 4-6 mL four times daily for 7-14 days 3, 1
- Alternative formulation: 1-2 nystatin pastilles (200,000 units each) four times daily for 7-14 days 3
- Treatment should continue for at least 48 hours after symptoms have resolved 2
Proper Administration Technique
- Instruct patients to swish the suspension thoroughly in the mouth, ensuring contact with all affected areas for as long as possible (at least 2 minutes) 1
- After swishing, the medication should be swallowed rather than spit out to treat potential esophageal involvement 1
- For optimal effectiveness, avoid eating or drinking for at least 5-10 minutes after administration 2
Treatment Considerations Based on Disease Severity
- For mild oral thrush: Nystatin suspension as described above is appropriate as first-line therapy 3, 1
- For moderate to severe disease: Oral fluconazole 100-200 mg daily for 7-14 days is recommended instead of nystatin 3
- For fluconazole-refractory disease: Consider itraconazole solution, posaconazole suspension, or voriconazole as alternatives 3
Special Populations and Considerations
- For denture-related candidiasis: Disinfection of the denture must accompany antifungal therapy 3, 1
- For immunocompromised patients: Systemic therapy with fluconazole may be more effective than topical nystatin 4, 5
- For HIV-infected patients: Antiretroviral therapy is strongly recommended to reduce recurrence rates 3, 1
- For patients with recurrent infections: Chronic suppressive therapy with fluconazole 100 mg three times weekly may be necessary 3
Efficacy Considerations
- Several studies have shown that systemic antifungals like fluconazole may be more effective than nystatin for immunocompromised patients 6, 4
- In comparative studies, clinical cure rates for nystatin have been lower than those for azole antifungals 4, 5
- Reinfection commonly occurs after cessation of therapy, particularly with denture-related candidiasis 7
Practical Tips
- Shake the nystatin suspension well before measuring the dose 2
- For infants and young children, use the provided dropper to place one-half of the dose in each side of the mouth 2
- Continue treatment for the full prescribed duration even if symptoms improve sooner to prevent recurrence 1
- Monitor for clinical improvement within 48-72 hours; if no improvement is seen, consider alternative diagnoses or treatments 3