Duration of Nystatin Treatment for Thrush
Nystatin should be used for 7-14 days for the treatment of oral thrush (oropharyngeal candidiasis). 1, 2
Recommended Dosing and Duration
- For mild oral thrush, nystatin suspension (100,000 U/mL) at a dosage of 4-6 mL four times daily for 7-14 days is recommended 1, 2
- Alternatively, 1-2 nystatin pastilles (200,000 U each) can be administered 4 times daily for 7-14 days 1, 2
- For infants, the FDA-approved dosage is 2 mL (200,000 units) four times daily, while for premature and low birth weight infants, 1 mL four times daily is effective 3
- For children and adults, 4-6 mL (400,000-600,000 units) four times daily is recommended 3
Treatment Completion Criteria
- Treatment should continue for at least 48 hours after perioral symptoms have disappeared and cultures demonstrate eradication of Candida albicans 3
- Clinical response to nystatin treatment should be evident within 48-72 hours 2
- Mycological cure typically occurs within 4-7 days 2
Special Considerations
- For denture-related candidiasis, disinfection of the denture in addition to antifungal therapy is essential, with treatment duration of 7-14 days 1, 2
- Immunocompromised patients may require extended treatment duration beyond the standard 7-14 days 2
- For moderate to severe thrush, oral fluconazole at a dosage of 100-200 mg daily for 7-14 days is more effective than nystatin 1, 4
Common Pitfalls and Caveats
- Nystatin should be retained in the mouth as long as possible before swallowing for maximum effectiveness 3
- In infants and young children, use a dropper to place one-half of the dose in each side of the mouth and avoid feeding for 5-10 minutes 3
- Nystatin is generally less effective than fluconazole for moderate-to-severe infections 2, 4
- Clinical studies have shown that fluconazole has higher clinical cure rates (91-100%) compared to nystatin (32-51%) for oral thrush 5, 4
- If symptoms persist beyond the recommended treatment duration, reevaluation for possible resistant organisms or alternative diagnoses is warranted 2
Treatment Algorithm
- For mild thrush in immunocompetent patients: Use nystatin suspension or pastilles for 7-14 days 1, 2
- For moderate to severe thrush: Consider fluconazole 100-200 mg daily for 7-14 days instead of nystatin 1
- For denture-related thrush: Use nystatin for 7-14 days AND disinfect dentures 1, 2
- For immunocompromised patients: May require extended treatment beyond 14 days 2
- Continue treatment for at least 48 hours after symptoms resolve 3