Nystatin Swish and Swallow for Oral Thrush
For mild oral thrush, use nystatin suspension 4-6 mL (400,000-600,000 units) four times daily for 7-14 days, swishing thoroughly in the mouth for at least 2 minutes before swallowing—not spitting out. 1, 2
Proper Administration Technique
- Swish the suspension thoroughly throughout the entire mouth for as long as possible (at least 2 minutes) to ensure contact with all affected oral surfaces 2
- Swallow the medication after swishing rather than spitting it out to treat potential esophageal involvement 2
- Administer 4-6 mL (400,000-600,000 units) four times daily 1, 2
- Continue treatment for the full 7-14 days even if symptoms resolve earlier 1, 2
Alternative Nystatin Formulation
- Nystatin pastilles (200,000 units each) can be used as an alternative, with 1-2 pastilles dissolved slowly in the mouth four times daily for 7-14 days 1, 2
When Nystatin Is NOT the Best Choice
For moderate to severe oral thrush, oral fluconazole 100-200 mg daily for 7-14 days is superior to nystatin and should be used instead. 1, 2
- Fluconazole demonstrates significantly higher cure rates (100% vs 32% in one study) compared to nystatin in infants 3
- In immunocompromised children, fluconazole achieved 91% clinical cure versus 51% with nystatin 4
- Systemic therapy is more appropriate for immunocompromised patients with recurrent infections 2
Critical Pitfalls to Avoid
- Do not use "swish and spit" technique—the medication must be swallowed to be effective for oral and potential esophageal candidiasis 2
- For denture-related candidiasis, disinfection of the denture must accompany antifungal therapy or treatment will fail 1, 2
- Nystatin has high recurrence rates; if thrush recurs, switch to fluconazole rather than repeating nystatin 3, 4
Special Populations
- HIV-infected patients: Antiretroviral therapy is strongly recommended to reduce recurrent infections; chronic suppressive therapy with fluconazole 100 mg three times weekly may be needed for frequent recurrences 1, 2
- Immunocompromised patients: Consider systemic fluconazole as first-line rather than topical nystatin due to superior efficacy 2, 4