NYSTATIN
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Nystatin is a topical antifungal which can provide symptomatic relief from vaginal candidiasis in 24-72 hours.6 Antifungal treatment can be given if VVC is suspected and there is low risk of STIs, antifungals were effective previously, or while waiting swab results.3 It is both fungi-static and fungi-cidal and can be used for fungal skin infections like VVC.7 It has been shown Nystatin treatment (100,000 IU for 6 days) is inferior to clotrimazole treatment (100mg for 6 days) as it is not as effective in curing VVC or reducing symptoms, as well as it has more relapses in treatment.4 However, longer durations of treatment with nystatin of 14 days may be as effective as imidazoles in treating uncomplicated VVC.1 Generally, topical imidazoles are more effective than nystatin in treating symptomatic vaginal candidiasis in pregnancy.5
Nystatin is also generally considered safe as topical nystatin is not absorbed systemically when applied to mucus membranes/intact skin and is considered safe in pregnancy.6 Adverse effects with topical/intravaginal nystatin are rare and mainly include irritation or pruritus.2 All women using vaginal/vulval antifungals should also be educated that the treatment may damage latex condoms, diaphragms and cervical caps.3 Although nystatin may be effective, it has a much longer treatment course and may stain clothes yellow.1 Instead intravaginal or oral imidazoles are suggested based on women’s preferences due to the inconvenience of nystatin.1
References:
1. Clarity Informatics Limited. (2007). Prodigy Clinical Topics: Candida – female genital. Retrieved June 21, 2012. http://prodigy.clarity.co.uk/candida_female_genital/view_whole_topic
2. Concolaro M, Da Silva M, Martins H, et al. Efficacy of Fluconazole and Nystatin in the Treatment of Vaginal Candida Species. Acta Derm Venereol. 2012; 92: 78-82.
3. FFPRHC, CEU, BASHH. The management of women of reproductive age attending non-genitourinary medicine settings complaining of vaginal discharge. Journal of Family Planning. and Reproductive Health Care. 2006; 32(1): 33-42.
4. Henderson J, Masterton G, Moffet M, et al. Six-day clotrimazole therapy in vaginal candidosis. Curr. Med. Res. Opin. 1975; 3(2): 83-88.
5. Jewell D, Young G. Topical Treatment for Vaginal Candidiasis (thrush) in Pregnancy. Cochrane Database of Systemic Reviews. 2010; (4): 1-18.
6. Lexi-Comp Online. http://online.lexi.com . Accessed June 2012.
7. RxFiles Drug Comparison Charts. 8th Edition. RxFiles 2010. Antifungal Treatment Chart. Page 52.
Nystatin is a topical antifungal which can provide symptomatic relief from vaginal candidiasis in 24-72 hours.6 Antifungal treatment can be given if VVC is suspected and there is low risk of STIs, antifungals were effective previously, or while waiting swab results.3 It is both fungi-static and fungi-cidal and can be used for fungal skin infections like VVC.7 It has been shown Nystatin treatment (100,000 IU for 6 days) is inferior to clotrimazole treatment (100mg for 6 days) as it is not as effective in curing VVC or reducing symptoms, as well as it has more relapses in treatment.4 However, longer durations of treatment with nystatin of 14 days may be as effective as imidazoles in treating uncomplicated VVC.1 Generally, topical imidazoles are more effective than nystatin in treating symptomatic vaginal candidiasis in pregnancy.5
Nystatin is also generally considered safe as topical nystatin is not absorbed systemically when applied to mucus membranes/intact skin and is considered safe in pregnancy.6 Adverse effects with topical/intravaginal nystatin are rare and mainly include irritation or pruritus.2 All women using vaginal/vulval antifungals should also be educated that the treatment may damage latex condoms, diaphragms and cervical caps.3 Although nystatin may be effective, it has a much longer treatment course and may stain clothes yellow.1 Instead intravaginal or oral imidazoles are suggested based on women’s preferences due to the inconvenience of nystatin.1
References:
1. Clarity Informatics Limited. (2007). Prodigy Clinical Topics: Candida – female genital. Retrieved June 21, 2012. http://prodigy.clarity.co.uk/candida_female_genital/view_whole_topic
2. Concolaro M, Da Silva M, Martins H, et al. Efficacy of Fluconazole and Nystatin in the Treatment of Vaginal Candida Species. Acta Derm Venereol. 2012; 92: 78-82.
3. FFPRHC, CEU, BASHH. The management of women of reproductive age attending non-genitourinary medicine settings complaining of vaginal discharge. Journal of Family Planning. and Reproductive Health Care. 2006; 32(1): 33-42.
4. Henderson J, Masterton G, Moffet M, et al. Six-day clotrimazole therapy in vaginal candidosis. Curr. Med. Res. Opin. 1975; 3(2): 83-88.
5. Jewell D, Young G. Topical Treatment for Vaginal Candidiasis (thrush) in Pregnancy. Cochrane Database of Systemic Reviews. 2010; (4): 1-18.
6. Lexi-Comp Online. http://online.lexi.com . Accessed June 2012.
7. RxFiles Drug Comparison Charts. 8th Edition. RxFiles 2010. Antifungal Treatment Chart. Page 52.
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