II. Indications

  1. Cutaneous Candidiasis (topical Nystatin)
    1. Candida Diaper Dermatitis
    2. Candidal Intertrigo
  2. Oral Candidiasis (Thrush)
    1. First-line agent
  3. Yeast Vaginitis
    1. Other medications are preferred

III. Contraindications

  1. Dermatophytes or tinea fungal infections (ineffective)

IV. Mechanism

  1. Macrolide Antifungal and Polyene Antifungal (as is Amphotericin B)
  2. Like Amphotericin B, Nystatin binds sterols in fungal plasma membranes, resulting in fungal cell leak and death
  3. Synthesized by the Bacteria streptomyces noursei, Staphylococcus aureus, and other Streptomyces species
  4. Three biologically active components (A1, A2, A3) form the Nystatin complex

V. Medications

  1. Topical Nystatin (100,000 units/gram)
    1. Available as a cream, ointment or powder
  2. Oral
    1. Suspension: 100,000 units/ml
    2. Film-coated tablets: 500,000 units

VI. Dosing: Topical for Cutaneous Candidiasis (topical Nystatin)

  1. Apply 2 to 3 times daily

VII. Dosing: Oral Candidiasis (Thrush)

  1. Adults
    1. Pastilles: 200,000 unit lozenge four times daily for 14 days
    2. Swish and swallow: 500,000 units (5 ml) four times daily for 14 days
    3. Tablets: Two 500,000 unit tablets three times daily for 14 days
  2. Child
    1. Swish and swallow 500,000 units (5 ml) orally four times daily for 14 days
  3. Infant
    1. Suspension (100,000 u/ml): Swab 1 ml on each cheek four times daily for 14 days
    2. Decrease dose in Preterm or low-birth weight infants to 0.5 ml/cheek
    3. Avoid feeding infant for 5 to 10 minutes after dose

VIII. Dosing: Yeast Vaginitis

  1. Nystatin vaginal tablet (100,000 unit) PV daily for 14 days
  2. Nystatin ointment (100,000 units/g)
    1. Ointments are less irritating than creams

IX. Safety

  1. Pregnancy category C
  2. Considered safe in Lactation

X. Pharmacokinetics

  1. When taken orally, Nystatin is not absorbed
  2. Excreted unchanged in feces

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Related Studies

Cost: Medications

nystatin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
NYSTATIN 100,000 UNIT/GM CREAM Generic $0.19 per gram
NYSTATIN 100,000 UNIT/GM OINT Generic $0.27 per gram
NYSTATIN 100,000 UNIT/GM POWD Generic $0.31 per gram
NYSTATIN 100,000 UNIT/ML SUSP Generic $0.09 per ml
NYSTATIN 500,000 UNIT ORAL TAB Generic $0.35 each