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Topical antiseptic + antifungal Pregnancy: As with all drugs, nystatin should be administered with caution during the early months of pregnancy, and its use requires that the anticipated benefits outweigh the possible risks.

Chlorhexidine with nystatin

Brand names: Nystaform

A topical/cutaneous preparation combining chlorhexidine, a cationic biguanide antiseptic, with nystatin, a polyene antifungal, used to treat or prevent superficial bacterial and candidal skin infection, particularly in moist or macerated flexural areas.

Adult dose

Dose: Apply to infected areas
Route: Topical (cutaneous) - for external use only
Frequency: 2 to 3 times daily
The SPC gives a single regimen for adults and children: apply to infected areas 2-3 times daily, continuing application for 1 week after the lesions have healed. The patient should be advised to return for further consultation if the condition has not improved within seven days; if the condition does not improve within 14 days of starting treatment, an alternative treatment should be substituted. Avoid contact with eyes. If sensitivity occurs, or if a new infection appears, discontinue use and institute alternative therapy. No dose by weight, age band or fingertip unit is stated, and no separate paediatric regimen is given. Fetched source is the Nystaform Cream SPC, which is the chlorhexidine-with-nystatin combination product, so both components are covered. (The openFDA record in this bundle is an unrelated single-component chlorhexidine gluconate 0.75% antiseptic handwash and was not used.)

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Known hypersensitivity to the active substance, especially in those with a history of possible chlorhexidine-related allergic reactions, or to any of the excipients

Side effects

  • Allergic skin reactions such as dermatitis, pruritus, erythema, eczema, rash, urticaria, skin irritation and blisters (frequency not known)
  • Hypersensitivity, including anaphylactic shock (frequency not known) - chlorhexidine is known to induce generalised allergic reactions
  • Local skin reactions (e.g. contact dermatitis) attributed to cetostearyl alcohol
  • Allergic reactions and mild local irritation attributed to benzyl alcohol (10 mg per gram of cream)

Interactions

  • None stated in the SPC (section 4.5: 'None stated.')

Clinical monograph

How it works

Chlorhexidine disrupts bacterial cell membranes and is bactericidal against a broad range of organisms, while nystatin binds ergosterol in the fungal cell membrane, increasing permeability and killing Candida species.

Prescribing in practice

  • Nystatin is not absorbed through intact skin and chlorhexidine has negligible systemic absorption, so the principal risk is local irritation or contact sensitisation rather than systemic toxicity.
  • Keep chlorhexidine away from the eyes, middle ear and meninges, as it can cause irritation of these tissues.
  • Reserve for confirmed or strongly suspected mixed bacterial and candidal infection rather than routine use, to limit sensitisation and resistance.

Monitoring

No laboratory monitoring is required; review the treated area clinically and stop if irritation, worsening or no improvement occurs.

Counselling the patient

  • Apply a thin layer to the affected area as directed and keep the skin clean and as dry as possible.
  • Stop and seek advice if the skin becomes more red, itchy or sore, which may indicate a reaction.

Evidence & guidelines

Topical antiseptic-antifungal combinations are long-established for superficial mixed skin infection; choice should follow local guidance and infection-control principles.

Reference: Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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