Nystatin pastilles and suspension in the treatment of oral candidosis

Abstract

Clinical audit revealed that the treatment of oral candidosis was more successful with nystatin pastilles than with nystatin suspension. The purpose of this investigation was to determine the reasons for this observation. The concentration of nystatin needed to kill 49 consecutive clinical isolates of Candida albicans was measured. The isolates varied in cidal concentrations from 1.875 to 30 U/ml. The time taken to kill these isolates at their cidal concentrations was found to vary from 120 to 300 min. Volunteer studies showed that antifungal activity in the oral cavity was eliminated rapidly after the use of nystatin suspension. In contrast, the polyene could be detected for at least 5 hours after use of the nystatin pastille. The nystatin pastille can be expected to be more effective at killing Candida albicans than the suspension due to its persistent effects.

Candidiasis and other fungal diseases of the mouth

“…In contrast, the pastilles and lozenges can be sucked slowly and hence have a longer duration of action. The sweetened formulations of pastilles and lozenges result in better patient compliance, and because of its prolonged retention, pastilles can be expected to be a better fungicidal agent than the suspension (35). Nystatin pastilles are ideal for the treatment of Candida-associated denture stomatitis (36) and in preventing recurrences of oral candidiasis in HIV-infected patients (37).…”

Novel Mucoadhesive Extended Release Tablets for Treatment of Oral Candidosis: “In Vivo” Evaluation of the Biopharmaceutical Performance

“…The comparative bioavailability of N suspensions and tablets has been published elsewhere 20. In that study, formulations containing N were administered by 5 min, then taken away from the oral cavity with the N concentration being quantified over the time.…”

Fungal infections associated with HIV infection

“…It is also possible that a previous episode of oral candidiasis was not totally resolved when the patient was placed on prophylactic treatment. A recommendation was presented to place nystatin pastilles on the essential drugs list for the treatment of HIV/AIDS patients because the pastilles have been shown to be more effective than the oral solution (Millns and Martin 1990). Miconazole was prescribed for the majority of patients presenting with pseudomembranous and erythematous candidiasis.…”