Nystatin Dosing for 3-Month Treatment
For a 3-month course of nystatin treatment, the standard dosing is nystatin suspension 4-6 mL (400,000-600,000 units) four times daily, though this prolonged duration is not typically recommended as first-line therapy due to poor efficacy and high relapse rates. 1
Standard Nystatin Dosing Regimens
- Nystatin suspension: 4-6 mL (400,000-600,000 units) four times daily, swished in the mouth as long as possible before swallowing 1
- Nystatin pastilles: 1-2 pastilles (200,000 units each) four times daily as an alternative or adjunctive formulation 1
- Combination therapy: Using both suspension and pastilles together achieves higher clinical and mycological cure rates than suspension alone 2
Critical Limitations of Prolonged Nystatin Therapy
Nystatin has significantly inferior efficacy compared to systemic azoles, with clinical cure rates of only 32-54% versus 87-100% for fluconazole, making it a poor choice for extended treatment. 3, 4
- Nystatin demonstrates high relapse rates even after standard 7-14 day courses 5
- For immunocompromised patients requiring prolonged therapy, systemic agents are more appropriate 1
- Poor tolerability and taste issues reduce compliance during extended treatment courses 2
Superior Alternative for 3-Month Treatment
For patients requiring 3 months of antifungal therapy (such as recurrent oral thrush), fluconazole 100 mg three times weekly is the evidence-based recommendation for chronic suppressive therapy rather than daily nystatin. 3, 1
- This regimen provides superior efficacy with better compliance due to less frequent dosing 3
- Chronic suppressive therapy is particularly indicated for HIV-infected patients or other immunocompromised individuals with recurrent infections 3, 1
When Nystatin May Be Appropriate for Extended Use
- Neonatal prophylaxis: Oral nystatin 100,000 units three times daily for 6 weeks is recommended for premature neonates <1500 g in settings where fluconazole is unavailable or contraindicated 6
- Leukemic patients during chemotherapy: Nystatin prophylaxis is mentioned for this specific population 6
Important Clinical Caveats
- If nystatin is used and fails after 7-14 days, switch to itraconazole solution 200 mg once daily, which is effective in approximately two-thirds of fluconazole-refractory cases 1
- For moderate-to-severe disease requiring extended treatment, systemic fluconazole (100-200 mg daily initially, then 100 mg three times weekly for maintenance) is strongly preferred over nystatin 3, 1
- Denture-related candidiasis requires concurrent denture disinfection regardless of antifungal choice 3, 1