Chlorhexidine with nystatin

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.