Nystatin: Brands, Price & Uses in Bangladesh

Nystatin is a polyene antifungal antibiotic used for the local (topical) treatment of infections caused by Candida species (yeast/fungal infections). It is not effective against systemic (blood-borne) fungal infections because it is very poorly absorbed from the mouth, skin, gut, or vagina.

Established/FDA-approved uses

• Oral candidiasis (oral thrush): Nystatin oral suspension is indicated for the treatment of candidiasis in the oral cavity in infants, children, and adults.
• Vulvovaginal candidiasis: Nystatin vaginal tablets are used for the local treatment of vaginal yeast infections caused by Candida albicans and other susceptible Candida species.
• Cutaneous and mucocutaneous candidiasis: Nystatin topical cream, ointment, or powder is used for skin and mucous-membrane infections caused by Candida, including candidal intertrigo (skin-fold infections) and candidal diaper rash.

Other/adjunct uses

• Prevention (prophylaxis) of oral or gastrointestinal candidiasis in immunocompromised patients (e.g. during chemotherapy, in neonatal intensive care) is a common but off-label/guideline-based practice in some settings; the decision should be made by a physician.

Note: Nystatin is only marketed and used in Bangladesh as a local/topical antifungal in oral suspension, vaginal tablet, and topical dosage forms, not as a systemic antifungal.

Oral candidiasis (oral suspension)

For infants, use the supplied dropper to place half the dose in each side of the mouth; avoid feeding for 5-10 minutes afterward. For children and adults, half the dose should be retained/swished in each side of the mouth for as long as possible (or as directed on the product label) before swallowing, since Nystatin works locally on contact and is not absorbed. Treatment should continue for at least 48 hours after symptoms have resolved, and typically for 7-14 days, to help prevent relapse.

Vulvovaginal candidiasis (vaginal tablet)

One vaginal tablet (100,000 units) inserted deep into the vagina once daily at bedtime, usually for 14 consecutive days, or as directed by the physician. Treatment should not be interrupted during menstruation unless advised otherwise.

Cutaneous/mucocutaneous candidiasis (topical cream/ointment/powder)

Apply a thin layer to the affected skin area 2-3 times daily until the infection has cleared and for a few days afterward, or as directed by the physician.

Nystatin should always be taken exactly as prescribed; do not stop, extend, skip doses, or share this medicine with others without medical advice, even if symptoms improve early, to ensure the infection is fully cleared and to prevent recurrence.

Nystatin is generally very well tolerated because of its minimal systemic absorption. Reported side effects are usually mild and local.

Common

• Mild oral irritation or an unpleasant/bitter taste (oral suspension)
• Nausea, vomiting, diarrhea, or general gastrointestinal upset, particularly with higher oral doses
• Local irritation, itching, or burning at the application site (vaginal or topical use)

Uncommon/rare

• Skin rash or hives (urticaria)
• Very rare: severe hypersensitivity reactions, including Stevens-Johnson syndrome, facial swelling, bronchospasm, or rapid heartbeat (tachycardia), have been reported

Patients should seek prompt medical attention for signs of a serious allergic reaction (swelling of the face/lips/throat, difficulty breathing, severe rash).