Johns Hopkins Antibiotic (ABX) Guide

Nystatin

Paul A. Pham, Pharm.D.; John G. Bartlett, M.D.

INDICATIONS

FDA

FORMS[Top]

brand name

preparation

manufacturer

route

form

dosage^

cost*

Nystatin

Nystatin

Generic manufacturers (Paddock, Teva and others)

oral

tablet

500,000U

$0.68

vaginal

tablet

100,000U

$0.47

Mycostatin

Nystatin

Generic manufacturers (Apothecon, Bristol-Myers Squibb, and others)

oral

suspension

100,000 U/mL ( 60mLor 480 mL)

$1.67per 5 mL

topical

powder

100,000U/gram

$5.50

topical

cream or ointment

100,000U/gram (15gm, 30gm)

$4.25 (15gm); $6.50 (30gm)

*Prices represent cost per unit specified, are representative of "Average Wholesale Price" (AWP).
^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING[Top]

  • Thrush: 500,000 to 1,000,000 Units (1-2 tabs or 5-10ml ) in mouth 3-5 x d. Put ½ of suspension in left side of mouth, hold as long as possible before swallowing. Repeat for right side of mouth.
  • Vaginitis: 1 vaginal tablet (100,000 units) daily for 2 weeks.
  • Topical candidiases: Apply cream or ointment to affected areas twice daily.

RENAL DOSING[Top]

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Usual dose

DOSING FOR GLOMERULAR FILTRATION OF 10-50

Usual dose

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

Usual dose

DOSING IN HEMODIALYSIS

Usual dose

DOSING IN PERITONEAL DIALYSIS

Usual dose

DOSING IN HEMOFILTRATION

Usual dose

ADVERSE DRUG REACTIONS[Top]

COMMON

  • Oral preparations: bad taste.

OCCASIONAL

  • Oral preparations: GI distress including nausea, vomiting and diarrhea.
  • Topical preparations: skin irritation.

DRUG INTERACTIONS[Top]

None

SPECTRUM[Top]

Candida albicans and other Candida spp . at higher concentrations; no activity against dermatophytes.

PHARMACOLOGY[Top]

MECHANISM

Binds to sterols in the fungal cell membrane resulting in loss of function.

PHARMACOKINETIC PARAMETERS

Absorption

No systemic absorption.

Metabolism and Excretion

Not metabolized.

Protein Binding

n/a

Cmax, Cmin, and AUC

Minimal absorption. Salivary concentration 1000 u/ml 1 hr post-dose.

T1/2

4 hrs

Distribution

Concentrated in saliva.

DOSING FOR DECREASED HEPATIC FUNCTION

Usual dose.

PREGNANCY RISK

Category B: No fetal harm has been reported.

BREAST FEEDING COMPATIBILITY

Compatible with breastfeeding.

COMMENTS[Top]

Causes GI side effects and may not be as effective as clotrimazole since the bitter taste prevents pts from keeping it in their mouth for prolong periods of time. Poor adherence due to frequent administration (suspension). Efficacy dependent on contact time with mucosa. Clotrimazole lozenges preferred by most pts. In contrast to topical clotrimazole, topical nystatin not effective for Tinea corporis.

Basis for recommendation[Top]

  • National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the HIV Medicine Association of the Infectious Diseases Society of America (HIVMA/IDSA); Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents; http://AIDSinfo.nih.gov/;

    Comment: Initial episodes of oropharyngeal candidiasis can be treated with topical therapy, such as clotrimazole troches or nystatin suspension.
    Rating: Basis for recommendation

References[Top]

  1. Pappas PG et al: Guidelines for treatment of candidiasis. Clin Infect Dis 38:161, 2004 Jan. 15  [PMID:14699449]

    Comment: Guidelines for the management of different forms of candidiasis. Topical nystatin or clotrimazole is recommended for oropharyngeal candidiasis.

  2. Pons V et al: Oropharyngeal candidiasis in patients with AIDS: randomized comparison of fluconazole versus nystatin oral suspensions. Clin Infect Dis 24:1204, 1997   [PMID:9195083]

    Comment: Systemic fluconazole therapy more effective compared topical nystatin with response seen in 87% of the fluconazole-treated pts compared to 52% in the nystatin-treated group (p < .001). Obvious concern is development of azole-resistance with chronic fluconazole treatment.

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Nystatin
Last updated: March 15, 2011
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