NYSTATIN

Mycostatin

Reviewed by Dr Carl Kuschel
May 2006
Administration Newborn Drug Protocol Index Newborn Services Home Page

Dose and Administration

Fungal prophylaxis 0.5 ml PO 12 hourly
Superficial skin infections Use cream or powder liberally
Gastrointestinal candidiasis 0.5-1.0 ml PO every 4-6 hours
Oral candidiasis 0.5-1.0 ml PO every 4-6 hours

Indications

  1. Prophylaxis for all neonates with risk factors for systemic candidiasis.
  2. Superficial skin infections with candida.
  3. Gastrointestinal candidiasis
  4. Oral candidiasis (first-line agent)

Contraindications and Precautions

  1. Hypersensitivity to nystatin
  2. Systemic fungal infections.
  3. Congenital candidiasis.

Clinical Pharmacology

Nystatin is a polyene antifungal antibiotic active against a wide range of yeasts and yeast-like fungi, including Candida albicans. Its action depends upon its binding to a sterole moiety, ergosterole, present in the membrane of sensitive fungi. May be fungicidal or fungistatic, depending on the drug concentration obtained and the sensitivity of the fungus. Does not have any appreciable activity against bacteria, protozoa or viruses. Nystatin is used primarily to treat candida infections of skin, mucous membranes and the gastrointestinal tract.

Very little nystatin is absorbed from the gastrointestinal tract, skin or mucous membranes. Patients with severe renal dysfunction may accumulate measurable quantities of the drug.

Possible Adverse Effects

  1. Gastrointestinal disturbances (nausea, vomiting and diarrhoea with very high doses).
  2. No systemic effects have been associated with its oral use.
  3. No allergic reactions have been associated with its oral use.

Special Considerations

  1. Not indicated in systemic or congenital candidiasis.
  2. For the treatment of oral candidiasis: the longer the suspension is kept in contact with affected area in the mouth, before swallowing, the greater will be its effect.
  3. Since the absorption of nystatin from the gastrointestinal tract is negligible, overdosage causes no systemic toxicity.
  4. Consider topical application to mother's nipples when infant has oral thrush.
  5. Continue oral nystatin for 48 hours after ceasing antibiotic therapy.