Nystatin Topical for Vulvovaginal Candidiasis: Dosage and Duration
For uncomplicated vulvovaginal candidiasis, nystatin 100,000-unit vaginal tablet should be administered once daily for 14 days, though azole antifungals are preferred over nystatin due to superior efficacy. 1
Recommended Nystatin Regimen
- Dosage: Nystatin 100,000-unit vaginal tablet 1
- Frequency: One tablet intravaginally daily 1
- Duration: 14 days 1
Critical Consideration: Nystatin is Second-Line Therapy
Topically applied azole drugs are more effective than nystatin for treating vulvovaginal candidiasis. 1 The CDC guidelines consistently list nystatin among treatment options but emphasize that azoles achieve 80-90% cure rates with symptom relief, making them the preferred first-line topical agents. 1
When Nystatin May Be Appropriate:
- Azole intolerance or allergy: When patients cannot tolerate azole medications 1
- Non-albicans Candida species: Nystatin may be effective for C. glabrata (64.3% cure rate) or fluconazole-resistant Candida where azoles have failed 2
- Recurrent vulvovaginal candidiasis (RVVC): For maintenance therapy, though nystatin ovules may not be as effective as azoles 3
Preferred Alternative Regimens (Higher Efficacy)
If nystatin is being considered, these azole options should be evaluated first:
- Clotrimazole 1% cream: 5g intravaginally for 7-14 days 1
- Miconazole 2% cream: 5g intravaginally for 7 days 1
- Terconazole 0.4% cream: 5g intravaginally for 7 days 1
- Fluconazole 150mg oral: Single dose (most convenient) 1
Important Clinical Caveats
Follow-Up Requirements:
- Patients should return only if symptoms persist or recur within 2 months 1
- Persistent symptoms after nystatin therapy warrant switching to an azole agent 1
Partner Management:
- Treatment of sexual partners is not routinely recommended 1
- Consider partner treatment only in women with recurrent infection 1
Pregnancy Considerations:
- Nystatin is safe during pregnancy, unlike oral fluconazole which should be avoided 3
- This represents one scenario where nystatin's longer treatment duration may be acceptable
Common Pitfall to Avoid
Do not prescribe nystatin for longer than 14 days for acute vulvovaginal candidiasis. 1 Extended durations (such as 4 weeks) exceed standard recommendations even for complicated cases and likely represent dosing errors. 4 For recurrent cases requiring maintenance therapy, use intermittent dosing (1-3 times weekly) after initial treatment rather than continuous extended therapy. 3