How to Use Nystatin for Oral Thrush
For treating oral thrush (oral candidiasis), nystatin suspension should be used at a dose of 4-6 mL (400,000-600,000 units) four times daily for 7-14 days, continuing for at least 48 hours after symptoms resolve. 1
Proper Administration Technique
- Shake the nystatin suspension well before each use 2
- For adults, use 4-6 mL (400,000-600,000 units) of nystatin suspension four times daily 1
- Swish the suspension in the mouth for as long as possible (at least 2 minutes) before swallowing or spitting out 2
- Apply after meals and at bedtime for best results 2
- Continue treatment for the full prescribed duration (7-14 days), even if symptoms improve earlier 2, 1
- Treatment should continue for at least 48 hours after symptoms have resolved 1
Alternative Formulations
- Instead of suspension, 1-2 nystatin pastilles (200,000 units each) can be used four times daily for 7-14 days 2
- Pastilles should be allowed to dissolve slowly in the mouth for maximum contact time with affected areas 2
- Pastilles may provide better efficacy than suspension alone based on descriptive studies 3
Important Considerations
- Nystatin topical cream is NOT indicated for oral use - only use formulations specifically designed for oral administration 4
- For moderate to severe oral thrush, oral fluconazole (100-200 mg daily for 7-14 days) may be more effective than nystatin 2
- Nystatin is not absorbed systemically when used orally, making it safe for most patients 1
- Common side effects include gastrointestinal upset and complaints about taste 3
Special Populations
- For infants with oral thrush, fluconazole suspension may be more effective than nystatin (100% vs 32% clinical cure rates in one study) 5
- For denture-related candidiasis, disinfection of dentures in addition to antifungal therapy is strongly recommended 2
Treatment Efficacy
- Clinical improvement should be seen within 48-72 hours of starting treatment 2
- If no improvement occurs after 7 days, reevaluation of diagnosis and consideration of alternative treatments is recommended 2
- For refractory cases not responding to nystatin, fluconazole or other systemic antifungals may be necessary 2