Topical Antifungal (Polyene)
Pregnancy: Safe — no systemic absorption; extensive use in pregnancy for candidal infections
Nystatin Cream/Powder
Brand names: Nystan, Timodine (with hydrocortisone)
Adult dose
Dose: Cream: apply 2–4 times daily; Powder: dust onto affected area 2–3 times daily
Route: Topical
Frequency: Two to four times daily for 2–4 weeks
Max: Continue for 7 days after resolution
Active against Candida spp. only — NOT active against dermatophytes (use clotrimazole instead). Powder form useful for intertriginous areas and under burns dressings where moisture accumulates. Not absorbed from skin — no systemic toxicity.
Paediatric dose
Route: Topical
Frequency: Two to four times daily
Max: 2–4 weeks
Safe in all ages including neonates. Powder form for oral thrush: 100,000 units/mL suspension, 1 mL four times daily.
Dose adjustments
Renal
No adjustment — not systemically absorbed.
Hepatic
No adjustment.
Clinical pearls
- Key distinction: nystatin is ONLY for Candida — no activity against dermatophytes. If uncertain, clotrimazole covers both Candida and dermatophytes.
- Nystatin powder under burn dressings reduces Candida colonisation in moist wound environments — particularly useful in skin folds and groin
- Oral nystatin suspension used alongside topical for prophylaxis in immunocompromised burns patients on prolonged antibiotics
Contraindications
- Hypersensitivity to nystatin
Side effects
- Local irritation (mild)
- Skin discolouration (yellow tinge from excipients)
- Allergic contact dermatitis (rare)
Interactions
- No significant interactions — not systemically absorbed
Monitoring
- Clinical response at 1 week
- Wound swab if not responding
Reference: BNFc; BNF 90; BNFc; BBA Burns Infection Management Guidelines. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.