Nystatin Treatment Guidelines

Dosing Recommendations

The American College of Physicians recommends nystatin suspension 4-6 mL (400,000-600,000 units) four times daily for 7-14 days for oral thrush in adults and children 1
The Infectious Diseases Society of America recommends nystatin pastilles 1-2 tablets (200,000 units each) four times daily for 7-14 days for oral thrush in adults and children 1
For neonatal prophylaxis, the American Academy of Pediatrics recommends 100,000 units of nystatin three times daily for 6 weeks in neonates with birth weights <1500 g 2, 3, 4, 5

The American Academy of Pediatrics recommends nystatin for neonates with birth weights <1500 g in settings where fluconazole is unavailable or resistance precludes its use, although this is a weak recommendation with moderate-quality evidence 2, 3, 4, 5
The Centers for Disease Control and Prevention recommends denture disinfection to accompany nystatin therapy for successful treatment of denture-related candidiasis 1
The HIV Medicine Association recommends antiretroviral therapy to reduce recurrence rates in HIV-infected patients with recurrent infections, and systemic therapy may be more appropriate than topical nystatin 1

The American Dental Association recommends swishing nystatin suspension thoroughly in the mouth for at least 2 minutes before swallowing to ensure contact with all affected areas 1
The American College of Physicians recommends completing the full 7-14 day course of nystatin even when symptoms resolve early 1

Routine oral nystatin therapy is not recommended for gastrointestinal decontamination, and nystatin should not be used for Candida isolated from the lower respiratory tract unless invasive disease is confirmed histopathologically. This guidance applies to patients with Candida colonization of the gut or respiratory tract and is based on the 2010 clinical guideline from the Journal of Microbiology, Immunology and Infection. 6