Nystatin

1. Introduction

Nystatin is an antifungal medication used to treat fungal infections caused by Candida species. It is effective for treating oral thrush, cutaneous candidiasis, and gastrointestinal fungal infections. Nystatin works by binding to ergosterol in the fungal cell membrane, causing membrane disruption and fungal cell death. It is not absorbed systemically when taken orally or applied topically.

2. Indications

  • Oral candidiasis (thrush)
  • Cutaneous candidiasis (skin infections caused by Candida)
  • Gastrointestinal candidiasis (prophylaxis or treatment in immunocompromised patients)
  • Vaginal candidiasis (as a topical treatment)

3. Dosage

Adults and Children:

  • Oral Candidiasis:
    • Suspension: 100,000 units (1 mL) 4 times daily. Retain in the mouth for as long as possible before swallowing. Continue for at least 48 hours after symptoms resolve.
  • Cutaneous Candidiasis:
    • Cream or ointment: Apply to the affected area 2–3 times daily until symptoms resolve.
  • Gastrointestinal Candidiasis:
    • Tablets: 500,000–1,000,000 units 3–4 times daily.

Infants:

  • Oral Candidiasis:
    • Suspension: 100,000 units (1 mL) applied to the inside of each cheek 4 times daily.

Elderly:

  • No specific dose adjustments are required.

4. Administration

  • For oral suspension, shake well before use.
  • Retain the suspension in the mouth for as long as possible before swallowing for maximum effect.
  • Apply topical formulations (cream, ointment, or powder) to clean, dry skin.
  • Avoid contact with the eyes.

5. Forms Available

  • Oral suspension: 100,000 units/mL
  • Tablets: 500,000 units, 1,000,000 units
  • Topical cream/ointment: 100,000 units/g
  • Topical powder: 100,000 units/g

6. Side Effects

6.1 Common Side Effects:

  • Mild gastrointestinal upset (nausea, diarrhoea) when taken orally
  • Skin irritation at the site of topical application

6.2 Less Common Side Effects:

  • Bitter taste (oral suspension)
  • Rash

6.3 Rare but Serious Side Effects:

  • Severe allergic reactions (e.g., swelling of the face, difficulty breathing)

7. Warnings

  • Allergic Reactions: Discontinue immediately if signs of hypersensitivity occur, such as rash or swelling.
  • Topical Use: Avoid applying to open wounds or broken skin, as absorption may increase the risk of irritation.

8. Precautions

  • Use cautiously in immunocompromised patients to ensure adequate fungal eradication.
  • Ensure compliance with full treatment duration to prevent recurrence of infection.

9. Interactions

  • Oral antifungals (e.g., fluconazole): Nystatin is often combined with systemic antifungals for severe infections. No significant interactions are noted.
  • No major drug interactions are known with Nystatin.

10. Monitoring Parameters

  • Monitor symptom resolution, such as reduced oral or skin irritation and lesion healing.
  • Assess for signs of persistent or worsening infection.

11. Use in Children

  • Safe and effective for oral thrush and cutaneous candidiasis in infants and children. Adjust dosage based on weight and infection site.

12. Use in Pregnancy

  • Generally considered safe for use during pregnancy, as it is not absorbed systemically when used topically or orally.

13. Use in Elderly

  • Well tolerated in elderly patients, with no specific precautions required.

14. Use in Kidney Disease

  • No dose adjustment is required, as Nystatin is not systemically absorbed.

15. Use in Liver Disease

  • No dose adjustment is necessary, as Nystatin is not systemically absorbed.

16. Patient Counselling Points

  • Use the medication exactly as prescribed, even if symptoms improve early.
  • Shake the oral suspension well before use and retain it in the mouth as long as possible before swallowing.
  • Apply topical formulations to clean, dry skin and avoid excessive use.
  • Report any persistent or worsening symptoms to your doctor.
  • Store the medication as instructed (some formulations may require refrigeration).

17. Table of Brand Names, Manufacturer, and Prices in USD

Brand NameManufacturerStrength/Dosage FormPrice (USD)
MycostatinValeant100,000 units/mL Suspension$20 (100 mL)
NystopPerrigo100,000 units/g Powder$15 (15 g)
Generic NystatinVarious500,000 units Tablets$10 (30 tablets)

18. 15 FAQs (Frequently Asked Questions)

1. What is Nystatin used for?
Nystatin is used to treat fungal infections caused by Candida species, including oral thrush, skin infections, and gastrointestinal candidiasis.

2. How does Nystatin work?
It binds to ergosterol in the fungal cell membrane, causing membrane damage and fungal cell death.

3. What is the usual dose of Nystatin for oral thrush?
The typical dose is 100,000 units (1 mL) of oral suspension, taken 4 times daily.

4. Can Nystatin be used in infants?
Yes, it is safe and commonly used for treating oral thrush in infants.

5. Is Nystatin absorbed into the bloodstream?
No, Nystatin is not systemically absorbed when taken orally or applied topically.

6. Can Nystatin be used during pregnancy?
Yes, it is generally considered safe during pregnancy due to minimal systemic absorption.

7. How long does it take for Nystatin to work?
Improvement in symptoms is usually seen within a few days, but treatment should be continued for at least 48 hours after symptoms resolve.

8. Can Nystatin cause side effects?
Yes, common side effects include mild gastrointestinal upset (oral use) and skin irritation (topical use).

9. Can Nystatin treat systemic fungal infections?
No, it is only effective for localised fungal infections, as it is not systemically absorbed.

10. How should Nystatin be stored?
Some formulations, like oral suspension, may require refrigeration. Follow storage instructions on the label.

11. Can Nystatin treat ringworm?
No, Nystatin is not effective against dermatophytes, which cause ringworm.

12. Can I stop using Nystatin once symptoms improve?
No, complete the full course of treatment to prevent recurrence of the infection.

13. Is a prescription required for Nystatin?
Yes, Nystatin is a prescription-only medication.

14. Can Nystatin be combined with other antifungals?
Yes, it can be combined with systemic antifungals for severe or refractory infections.

15. What should I do if I miss a dose?
Take the missed dose as soon as possible, but skip it if it’s close to the next dose. Do not double the dose.