Nystatin

How it works

It binds ergosterol in the fungal cell membrane, forming pores that increase permeability and cause leakage of intracellular contents, giving fungicidal activity chiefly against Candida species.

Prescribing in practice

• It is essentially not absorbed from the gut, so it acts only on local mucosal or luminal Candida and is ineffective for systemic or deep candidal infection.
• For oral candidiasis the suspension should be retained in the mouth in contact with the affected areas before swallowing to maximise local effect.
• Continue treatment for the recommended period after lesions clear to reduce relapse, and consider treating predisposing factors such as poor denture hygiene.

Monitoring

Routine laboratory monitoring is not required; assess clinical response and consider further investigation if oral or gastrointestinal candidiasis fails to resolve.

Counselling the patient

• Hold the suspension in your mouth, swishing it around the affected areas, before swallowing.
• Keep using it for a few days after the soreness or white patches have gone.
• If you wear dentures, clean them well and leave them out overnight to help clear the infection.

Evidence & guidelines

Topical and oral nystatin is a long-established standard treatment for localised mucocutaneous candidiasis.