Nystatin 💊
Related Subjects:
|Candidiasis
|Cutaneous fungal infections
|Amphotericin B
💊 Nystatin is a polyene antifungal used for superficial *Candida* infections of the mouth, gut lumen and skin. It is not absorbed from the gut or skin, so it is useless for systemic or invasive fungal infection.
📖 About
- For oral candidiasis, miconazole oral gel is usually first line (NICE CKS); nystatin is used when miconazole is unsuitable - e.g. patients on warfarin (miconazole markedly raises INR).
- Always check the BNF for the most up-to-date details.
⚙️ Mode of Action
- Binds ergosterol in the fungal cell membrane → pores form → leakage of cell contents and cell death.
- Fungistatic/fungicidal depending on concentration; active against *Candida* species.
🎯 Indications
- Oral and oropharyngeal candidiasis (including denture stomatitis).
- Prophylaxis of oral candidiasis in selected immunosuppressed patients.
- Cutaneous candidiasis (intertrigo, napkin candidiasis) - usually as a cream, sometimes combined with a mild corticosteroid.
💊 Dose
| Indication | Preparation | Dose |
|---|
| Oral candidiasis (adult and child ≥1 month) | Oral suspension 100,000 units/mL | 1 mL four times daily after food, usually for 7 days, and continue for 48 hours after lesions have resolved |
| Cutaneous candidiasis | Cream 100,000 units/g | Apply 2–4 times daily, continuing for 7 days after healing |
🦷 How to Use the Suspension
- Hold in the mouth or apply to lesions before swallowing; take after food and avoid eating or drinking for a short time afterwards.
- Remove dentures, clean them and soak overnight in an antifungal-compatible cleanser; treat the denture surface as well.
- Look for a cause: inhaled corticosteroids (rinse mouth after use), antibiotics, diabetes, iron/B12 deficiency, HIV.
🔄 Interactions
- None clinically significant - negligible systemic absorption.
⚠️ Cautions
- Suspensions contain sucrose - consider dental caries with prolonged use.
- Refer or investigate if candidiasis is recurrent, extensive or unresponsive (consider immunosuppression).
🚫 Contraindications
- Hypersensitivity to nystatin or excipients.
💥 Side Effects
- Oral: nausea, vomiting, diarrhoea (high doses), oral irritation.
- Topical: local irritation, rarely contact dermatitis.
- Rare: hypersensitivity, Stevens–Johnson syndrome.
📚 References
