Nystatin Powder Dosing for Fungal Infections
For cutaneous candidiasis, apply nystatin topical powder (100,000 units per gram) to affected areas 2-3 times daily until complete healing is achieved. 1
Dosing by Clinical Indication
Cutaneous Candidiasis (Skin Infections)
- Apply topical powder 2-3 times daily to candidal lesions until healing is complete 1
- Very moist lesions are best treated with the dusting powder formulation rather than creams or ointments 1
- For fungal foot infections caused by Candida species, dust powder on feet AND inside all footwear 1
- Store at controlled room temperature 15-30°C (59-86°F); avoid excessive heat above 40°C 1
Oropharyngeal Candidiasis (Oral Thrush)
While the question asks about powder, oral formulations are more appropriate for oropharyngeal disease:
- Nystatin suspension: 200,000-400,000 units orally 4 times daily for 7-14 days for mild disease 2
- Alternatively, nystatin pastilles: 1-2 pastilles (200,000 units each) 4 times daily for 7-14 days 2
- Treatment duration of 7-14 days for uncomplicated disease (1-7 days in children) 2
Important Clinical Considerations
When NOT to Use Nystatin Powder
- Do not use for systemic, oral, intravaginal, or ophthalmic infections 1
- Nystatin powder is specifically for topical cutaneous use only 1
- For moderate-to-severe oral candidiasis, fluconazole 100-200 mg daily for 7-14 days is preferred over nystatin 2
Treatment Duration Principles
- Continue treatment until complete healing, not just symptomatic relief 1
- Patients should complete the full prescribed course even if symptoms improve within the first few days 1
- For oral candidiasis, evidence suggests 4 weeks of treatment may be more effective than 2 weeks for achieving mycological cure 3
Monitoring and Follow-up
- If no therapeutic response occurs, repeat KOH smears, cultures, or other diagnostic methods to confirm diagnosis 1
- Discontinue treatment if irritation or sensitization develops 1
- Confirm diagnosis with appropriate diagnostic methods to rule out other pathogens 1
Safety Profile
- No adverse drug reactions were noted in prophylactic studies of neonates 4
- Most common adverse effects: poor taste and gastrointestinal reactions (primarily with oral formulations) 3
- Safe for use in pediatric patients from birth to 16 years 1
- Use in pregnancy only if potential benefit outweighs risk (Category C) 1
Common Pitfalls to Avoid
- Do not interrupt therapy prematurely when symptoms improve—complete the full course 1
- Do not use powder for systemic infections—it has no role in treating invasive candidiasis 1
- For oral candidiasis, nystatin suspension alone has lower efficacy than combination therapy with pastilles, or fluconazole for moderate-severe disease 2, 3