Nystatin Dosing for Adults
For adults with oropharyngeal candidiasis, nystatin suspension should be dosed at 4-6 mL (400,000-600,000 units) four times daily, with the medication retained in the mouth as long as possible before swallowing, continued for 7-14 days. 1, 2
Standard Dosing Regimens
Nystatin Suspension
- Dose: 4-6 mL (400,000-600,000 units) four times daily 1, 2
- Administration technique: Place half the dose in each side of the mouth and hold as long as possible before swallowing 1
- Duration: 7-14 days for mild oropharyngeal candidiasis 2
- Continue treatment for at least 48 hours after symptoms resolve and cultures confirm eradication of Candida 1
Nystatin Pastilles (Troches)
- Dose: 1-2 pastilles (200,000 units each) four times daily 2
- Duration: 7-14 days 2
- Higher doses (400,000 units) demonstrate significantly better mycological cure rates compared to 200,000 units 3
Clinical Context and Effectiveness
When Nystatin is Appropriate
- Mild oropharyngeal candidiasis is the primary indication where nystatin serves as first-line therapy alongside clotrimazole 2
- Nystatin pastilles are significantly superior to placebo for denture stomatitis 3
When to Choose Alternative Therapy
- For moderate to severe oropharyngeal candidiasis, oral fluconazole 100-200 mg daily for 7-14 days is superior and recommended over nystatin 2
- Nystatin suspension is not superior to fluconazole in immunocompromised patients, with clinical cure rates of only 51% versus 91% for fluconazole 4
Optimizing Treatment Success
Combination Approach
- Using nystatin suspension and pastilles together for 2 weeks achieves higher clinical and mycological cure rates than suspension alone 3
- Pastilles alone demonstrate higher mycological cure rates compared to suspension alone 3
Duration Considerations
- Extended treatment (4 weeks) with pastilles appears more effective than 2 weeks for achieving better clinical outcomes 3
- The standard 7-14 day duration is adequate for uncomplicated cases 2, 5
Special Situations
Denture-Related Candidiasis
- Standard nystatin dosing (4-6 mL four times daily or 1-2 pastilles four times daily) for 7-14 days 2, 5
- Disinfection of the denture is mandatory in addition to antifungal therapy to prevent reinfection 2
Vaginal Candidiasis
- Nystatin 100,000-unit vaginal tablets once daily for 14 days 2, 5
- This is a longer duration than most azole regimens but necessary for nystatin effectiveness 6
Common Pitfalls
- Reinfection is common after nystatin therapy if underlying factors (dentures, immunosuppression) are not addressed 7
- Poor taste and gastrointestinal adverse effects are the most common side effects 3
- Nystatin is generally less effective than fluconazole for moderate-to-severe or systemic infections 5
- Clinical response should be evident within 48-72 hours; if not, consider alternative diagnosis or resistant organisms 5