Duration of Nystatin Treatment for Intestinal Candidiasis
For intestinal candidiasis, treat with oral nystatin 500,000 units every 8 hours for 10 days, based on clinical case evidence and standard dosing protocols. 1
Treatment Protocol
Standard Dosing Regimen
- Administer nystatin 500,000 units orally every 8 hours (three times daily) for 10 days for documented intestinal candidiasis 1
- This regimen has demonstrated satisfactory clinical outcomes in published case reports of intestinal candidiasis following antibiotic-induced dysbiosis 1
FDA-Approved Dosing for Oral Candidiasis (for reference)
- Adults and children: 400,000-600,000 units (4-6 mL) four times daily 2
- Treatment should continue for at least 48 hours after symptoms resolve and cultures confirm eradication of Candida albicans 2
- The medication should be retained in the mouth as long as possible before swallowing 2
Important Clinical Considerations
Adjunctive Therapy
- Concurrent administration of intestinal microbiota restoratives (probiotics) is recommended to help restore normal gut flora, particularly when candidiasis follows broad-spectrum antibiotic use 1
- This combination approach addresses both the fungal overgrowth and the underlying dysbiosis that predisposed to infection 1
Treatment Duration Rationale
- The 10-day duration for intestinal candidiasis is longer than the minimum 7-day course used for oral thrush 3, 2
- This extended duration accounts for the need to eradicate candida throughout the gastrointestinal tract, not just the oral cavity 1
Common Pitfalls to Avoid
Premature Discontinuation
- Do not stop treatment when symptoms improve—complete the full 10-day course to prevent recurrence 1
- Symptomatic improvement often precedes complete mycological clearance 2
Inadequate Dosing
- Ensure adequate dosing frequency (every 8 hours) rather than the four-times-daily regimen used for oral candidiasis, as intestinal involvement may require different pharmacokinetic considerations 1
Failure to Address Underlying Causes
- Identify and correct predisposing factors such as prolonged antibiotic use, immunosuppression, or other conditions that disrupt normal intestinal flora 1
- Without addressing these factors, recurrence rates may be high 1
Alternative Considerations
When Nystatin May Be Inadequate
- For severe or refractory intestinal candidiasis, systemic azole therapy (fluconazole) may be more appropriate than topical nystatin 4, 5
- Fluconazole has demonstrated superior efficacy compared to nystatin in multiple clinical scenarios, though most data pertains to oral rather than intestinal candidiasis 4, 5