How is nystatin (antifungal medication) cream typically ordered for a patient with a cutaneous fungal infection?

How to Order Nystatin Cream for Cutaneous Fungal Infections

Nystatin topical powder (not cream) should be ordered as 100,000 units per gram applied to the affected area 2-3 times daily for 7-14 days, with instructions to keep the area dry between applications. 1

Important Clarification on Formulation

• Nystatin is primarily available as a topical powder, not cream, for cutaneous candidiasis treatment 1
• The FDA-approved formulation is nystatin topical powder at a concentration of 100,000 USP units per gram 1
• The powder formulation is specifically advantageous for skin fold infections where moisture accumulation is problematic, particularly in obese and diabetic patients 2

Standard Ordering Instructions

Prescription Details

• Drug name: Nystatin Topical Powder, USP
• Concentration: 100,000 units per gram 1
• Frequency: Apply to affected area 2 or 3 times daily 1
• Duration: 7-14 days for most cutaneous candidiasis cases 2, 3
• Quantity: Typically 15 grams per container 1

Application Instructions to Include

• Clean and thoroughly dry the affected area before each application 2
• Keep the infected area dry between applications, which is critical for treatment success, particularly in intertriginous areas 2
• Continue treatment for at least 48 hours after complete resolution of visible symptoms to prevent early relapse 2

Treatment Duration Algorithm

Standard Cases

• 7-14 days for uncomplicated cutaneous candidiasis 2, 3
• Continue for full duration even if symptoms improve earlier 2, 3

Extended Duration Scenarios

• Beyond 14 days for immunocompromised patients 2
• Longer duration may be necessary for Candida glabrata infections, which are more resistant 3

When to Escalate or Change Therapy

Consider Combination Therapy

• Add oral fluconazole 100-200 mg daily for 7-14 days alongside topical nystatin for moderate-to-severe infections 3

Switch to Alternative Agent

• If no improvement within 48-72 hours, consider alternative diagnoses, resistant organisms, or need for systemic therapy 2
• After 7 days without improvement, consider alternative diagnoses or resistant organisms 3
• After 14 days of failure, switch to azole antifungals (clotrimazole or miconazole) rather than continuing nystatin 3

Critical Caveats

Appropriate Use Only

• Nystatin topical powder is indicated only for cutaneous or mucocutaneous mycotic infections caused by Candida albicans and other susceptible Candida species 1
• Not indicated for systemic, oral, intravaginal, or ophthalmic use 1
• Should not be used for systemic or invasive fungal infections 2

Storage Requirements

• Store at controlled room temperature 15°-30°C (59°-86°F) 1
• Avoid excessive heat (40°C; 104°F) 1

Alternative Topical Agents

• Topical azoles (clotrimazole and miconazole) are equally effective alternatives to nystatin for cutaneous infections 2