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Drug dosage identifier

Nystatin

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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

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

Contraindications and precautions

  • Hypersensitivity to nystatin
  • Systemic fungal infections.
  • 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

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

Special considerations

  • Not indicated in systemic or congenital candidiasis.
  • 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.
  • Since the absorption of nystatin from the gastrointestinal tract is negligible, overdosage causes no systemic toxicity.
  • Consider topical application to mother's nipples when infant has oral thrush.
  • Continue oral nystatin for 48 hours after ceasing antibiotic therapy.

Management of Nystatin administration

Description

  • Oral suspension: Yellow. 100,000 units/ml
  • Dusting powder: 100,000 units/gm dispersed in talc. 15g containers
  • Topical ointment: 100,000 units/gm in 15gm tubes

Prescription

Oral

  • Charted on prescription chart in ml/dose

Topical powder

  • Charted on prescription chart as 1 puff to specified site.

Topical ointment

  • Charted on prescription chart as topical application

Administration

Oral

  • Shake well before use.
  • For active infection:
    • Apply suspension to all areas in the mouth with a syringe.
    • Administer after the feed: milk deactivates the drug.
  • For prophylactic use:
    • Administer orally or via NG tube after the feed.
    • To prevent blockage of the tube with nystatin, clear with a little air after administration.

Topical Ointment

  • Avoid contact of drug with your skin.
  • Apply ointment to mycotic lesions using a gloved hand or with a swab or applicator.

Topical Powder

  • Apply one puff to specified site.

Nursing considerations

  • Observe for signs of adverse effects.
  • Provide frequent oral care.
  • If dummy is used, change daily to avoid reinfection.
  • Continue treatment for at least 48-72 hours after lesions disappear or antibiotics are ceased.

Storage

  • Oral suspension: Store below 25°C
  • Powder: Store below 25°C - keep tightly closed
  • Ointment: Store below 25°C - avoid freezing

References

  1. Roberts RJ. Drug therapy in infants: Pharmacologic principles and clinical experience. Philadelphia, WB Saunders Co 1984 p81.

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Document Control

  • Date last published: 31 May 2006
  • Document type: Drug Dosage Guideline
  • Services responsible: ADHB Pharmacy, Neonatology
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years