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Nystatin

Pronunciation

Class: Polyenes
VA Class: AM700
CAS Number: 1400-61-9
Brands: Mycostatin, Mykacet, Nystat-Rx, Nystop, Pedi-Dri

Introduction

Antifungal; polyene antibiotic.128 129 130 131 133 134 150

Uses for Nystatin

Cutaneous and Mucocutaneous Candidiasis

Treatment of cutaneous infections caused by Candida,128 130 133 147 148 149 including perlèche, intertriginous candidiasis, and paronychia.e Used topically alone128 133 147 149 or in fixed combination with a corticosteroid (triamcinolone acetonide).130

Treatment of candidal diaper dermatitis.114 115 149 150 Treatment of choice is a topical antifungal (e.g., nystatin, clotrimazole, miconazole);115 may be used in conjunction with a topical corticosteroid.130 e 149 The majority of infants with candidal diaper dermatitis harbor C. albicans in their intestines and infected feces appear to be an important source of the cutaneous infection.115 Some clinicians recommend that an oral antifungal agent (e.g., oral nystatin) be administered concomitantly to treat the intestinal infection,115 but studies have not provided evidence that concomitant oral and topical therapy is more effective than topical therapy alone.114 115

Oropharyngeal Candidiasis

Treatment of oropharyngeal candidiasis (thrush).111 126 131 146 149

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Uncomplicated oropharyngeal candidiasis usually can be treated using oral topical therapy (clotrimazole lozenge or nystatin oral suspension); systemic oral antifungals (fluconazole, itraconazole, ketoconazole) usually are reserved for treatment of oropharyngeal candidiasis unresponsive to oral topical antifungals or for severe oropharyngeal candidiasis with esophageal involvement.111 126 Some clinicians prefer to use systemic oral azole antifungals for initial therapy of oropharyngeal candidiasis in HIV-infected individuals.111 112

Nystatin is ineffective for treatment of esophageal candidiasis in HIV-infected individuals.111 112

Intestinal Candidiasis

Oral treatment of mucous membrane (nonesophageal) GI candidiasis.131 134

Has been used orally in conjunction with an intravaginal antifungal to treat coexisting intestinal candidiasis and vulvovaginal candidiasis.100 101 (See Vulvovaginal Candidiasis under Uses.)

Vulvovaginal Candidiasis

Treatment of vulvovaginal candidiasis.102 108 119 122 129 CDC and other clinicians recommend that uncomplicated vulvovaginal candidiasis (defined as vulvovaginal candidiasis that is mild to moderate, sporadic or infrequent, most likely caused by C. albicans, or occurring in immunocompetent women) be treated with an intravaginal azole antifungal (e.g., butoconazole, clotrimazole, miconazole, terconazole, tioconazole) or, alternatively, oral fluconazole.102 108 116 118 119 122 123 127 Intravaginal nystatin can be used for uncomplicated vulvovaginal candidiasis,102 108 127 but generally is less effective than intravaginal azole antifungals.102 127

Has been used orally in conjunction with an intravaginal antifungal to treat coexisting intestinal candidiasis and vulvovaginal candidiasis.100 101 While early studies provided some limited evidence that reducing intestinal candidal colonization could improve the mycologic response and reduce the recurrence rate of vulvovaginal candidiasis,100 101 most evidence suggests that combined oral and intravaginal therapy does not substantially reduce the risk of recurrence compared with intravaginal therapy alone.103 104 105 106

Topical treatment of male sexual partners of women with recurrent vulvovaginal candidiasis who have symptomatic balanitis or penile dermatitis.102 Routine treatment of asymptomatic male sexual partners of women with recurrent vulvovaginal candidiasis is not recommended but may be considered when the woman has recurrent infections.102 120 124

Prevention of Candida Infections

Oral nystatin has been used for prevention of initial or recurrent mucocutaneous candidiasis (including oropharyngeal candidiasis) in HIV-infected individuals,110 but is no longer included in the prophylaxis guidelines of the Prevention of Opportunistic Infections Working Group of the US Public Health Service and Infectious Diseases Society of America (USPHS/IDSA).109 If prophylaxis of mucocutaneous candidiasis is indicated in HIV-infected individuals with history of frequent or severe episodes of oropharyngeal, esophageal, or vaginal candidiasis, USPHS/IDSA recommends fluconazole or, alternatively, itraconazole.109

Oral nystatin has been used in various regimens for prophylaxis against candida infections during periods of iatrogenic neutropenia in patients receiving immunosuppressive therapy (e.g., patients with malignancies, transplant recipients).135 136 137 138 139 140 144 Routine primary antifungal prophylaxis in neutropenic patients is not recommended, but may be considered in certain carefully selected high-risk patients (e.g., solid organ transplant recipients, patients in institutions that have a high incidence of fungal infections).141 143 145 If primary prophylaxis against candida infections is used in cancer or transplant recipients, many clinicians recommend oral fluconazole.141 143

Nystatin Dosage and Administration

Administration

Apply topically to the skin as a cream, ointment, or powder.128 130 133 147 148 Administer topically to the oral cavity as an oral suspension.131 146 Administer intravaginally as a vaginal tablet.129 Administer orally as film-coated tablets.134

Topical creams, ointments, or powders should not be ingested, applied to the eye, or administered intravaginally.128 130 133 e

Topical Administration

When treating cutaneous candidiasis, use proper hygiene and skin care measures to prevent spread of infection and reinfection; keep affected areas dry and exposed to air if possible.e

Cream may be preferred instead of ointment in intertriginous areas; powder may be preferred if lesions are very moist.147

Avoid occlusive dressings.e

Cream or Ointment

Apply cream or ointment to affected area and gently and thoroughly massage into the skin.128 130 147 148

Powder

Apply powder to affected areas.133

For treatment of candidal foot infections, dust powder onto feet and into shoes and stockings.128 133

Oral Topical Administration

For Oral Suspension

The powder for oral suspension is used by the patient to extemporaneously prepare each individual dose at the time of administration.131 Add the appropriate dose of powder (units of nystatin) to the volume of water recommended by the manufacturer (e.g., 118–177 mL) and stir well until suspended.131

Place one-half of the oral suspension in one side of the mouth and retain in the mouth for as long as possible before swallowing.131 Repeat using the remainder of the oral suspension in the other side of the mouth.131

Suspension

Shake suspension well before using.146

Place one-half of the dose in each side of the mouth (use a dropper in infants and young children) and retain in the mouth as long as possible before swallowing.146 Do not feed infants for 5–10 minutes after the dose.146

Intravaginal Topical Administration

Insert vaginal tablet high in the vagina using the applicator provided by the manufacturer.129

Continue intravaginal nystatin during menstruation.129 Cleansing douches may be used by nonpregnant patients; adjunctive anti-infective douches are unnecessary.129

Dosage

Pediatric Patients

Cutaneous Candidiasis
Topical

Cream, ointment, or powder: Apply to affected areas 2 or 3 times daily for ≥2 weeks.128 133 147 148 e

Candidal Diaper Dermatitis
Topical

Cream, ointment, or powder: Apply to affected areas several times daily for 7–10 days.114 150

Fixed-combination cream or ointment containing nystatin and triamcinolone acetonide: Apply to affected area in the morning and evening.130 e

Oral

Oral suspension: As an adjunct to topical nystatin, some clinicians recommend oral administration of 100,000 units of nystatin 4 times daily.e 132

Oropharyngeal Candidiasis
Oral Topical

Oral suspension: 200,000 units 4 times daily in infants or 400,000–600,000 units 4 times daily in children.131 146 Limited data indicate that 100,000 units 4 times daily is effective in premature and low birthweight infants.146

Continue treatment for 14 days or for ≥48 hours after perioral symptoms have disappeared and cultures have returned to normal.131 146 If symptoms persist, confirm the diagnosis of candidiasis and rule out other pathogens before initiating another course of nystatin therapy.131

Adults

Cutaneous Candidiasis
Topical

Cream, ointment, or powder: Apply to affected areas 2 or 3 times daily for ≥2 weeks.128 133 147 148 e

Fixed combination cream or ointment containing nystatin and triamcinolone acetonide: Apply to affected area in the morning and evening.130

Symptomatic improvement of cutaneous or mucocutaneous candidal infections usually occurs within 1–3 days; however, continue therapy for ≥2 weeks.e Discontinue therapy only after 2 successive negative tests for Candida.e

Clinical and mycologic cure for chronic paronychia may require several months of therapy.e

Oropharyngeal Candidiasis
Oral Topical

Oral suspension: 400,000 to 600,000 units 4 times daily.131 146 In HIV-infected individuals, 500,000 to 1,000,000 units 3–5 times daily.111

Continue treatment for 14 days or for ≥48 hours after perioral symptoms have disappeared and cultures have returned to normal.131 If symptoms persist, confirm the diagnosis of candidiasis and rule out other pathogens before initiating another course of nystatin therapy.131

Intestinal Candidiasis
Oral

Oral suspension prepared using the powder for oral suspension: 500,000 to 1 million units 3 times daily for ≥48 hours after clinical cure.131

Film-coated tablets: 2 tablets (500,000 to 1 million units) 3 times daily for ≥48 hours after clinical cure.131

Vulvovaginal Candidiasis
Intravaginal

Vaginal tablet: 1 tablet (100,000 units) once daily for 14 days.102 129

Cautions for Nystatin

Contraindications

Warnings/Precautions

Sensitivity Reactions

Hypersensitivity Reactions

Irritation or sensitization may occur.129 Rash, urticaria, and Stevens-Johnson syndrome reported rarely.128 133 134

Discontinue therapy if irritation or sensitization occurs.128 129 131 133 134 146 147 148

General Precautions

Selection and Use of Antifungals

Nystatin topical creams, ointments, or powders should not be used for treatment of systemic, oral, ophthalmic, or intravaginal infections.128 133

Nystatin oral suspension or film-coated oral tablets should not be used for treatment of systemic fungal infections.134 146

Prior to use of topical nystatin for treatment of cutaneous or mucocutaneous Candida infections128 133 and prior to use of intravaginal nystatin tablets for treatment of vulvovaginal candidiasis, diagnosis should be confirmed by microscopic examination (saline or potassium hydroxide [KOH] wet mount or Gram stain) and/or culture.102 119 128 129 133

If symptoms persist after initial treatment, confirm the diagnosis and rule out other pathogens before initiating another course of nystatin.128 130 133

Use of Fixed Combinations Containing Corticosteroids

When nystatin is used in fixed combination with a corticosteroid, consider the cautions, precautions, and contraindications associated with topical corticosteroid therapy.130 e i

Specific Populations

Pregnancy

Category A (vaginal tablets).129

Category C (topical creams, ointments, and powders).128 133

Category C (oral suspension and film-coated oral tablets).134 146

Category C (topical creams containing fixed combination of nystatin and triamcinolone acetonide).130

Lactation

Not known whether nystatin distributed into milk; use with caution.128 130 133 134 146

Not known whether triamcinolone acetonide distributed into milk; use fixed-combination preparations containing nystatin and triamcinolone acetonide with caution.130

Pediatric Use

Topical cream and topical powder may be used in pediatric patients, including neonates.128 133

Safety and efficacy of vaginal tablets not established in pediatric patients.129

Fixed-combination preparations containing nystatin and triamcinolone acetonide have been used effectively for treatment of cutaneous candidiasis in a limited number of children 2 months to 12 years of age.130 Pediatric patients may be more susceptible to topical corticosteroid-induced hypothalamic-pituitary-adrenal (HPA) axis suppression and Cushing’s syndrome than mature individuals because of the greater skin surface area-to-body weight ratio.130 134 e

Common Adverse Effects

Topical creams, ointments, or powders: Hypersensitivity reactions (burning, itching, rash, eczema, pain).128 133

Oral suspension or film-coated oral tablets: Mild and transitory GI effects (nausea, vomiting, diarrhea, GI distress); hypersensitivity reactions.131 146

Nystatin Pharmacokinetics

Absorption

Bioavailability

Not absorbed following topical application to intact skin or mucous membranes.128 129 130 133

Insignificant absorption occurs in most patients following oral administration.131 134 146 Usually undetectable in plasma when given in usual oral doses,131 but clinically important plasma concentrations may occur occasionally in patients with renal impairment.134 146

Elimination

Elimination Route

Following oral administration, majority of nystatin dose is excreted unchanged in feces.131 134 146

Stability

Storage

Topical

Cream or Ointment

15–30°C; avoid freezing and excessive heat (40°C).128 133 147 148

Powder

Tight container at 15–30°C; avoid excessive heat (40°C).128 133

Oral Topical

Powder For Oral Suspension

Tight, light resistant container at 2–8°C.131 Potency of the powder can only be assured for up to 90 days after the container is first opened.131

Contains no preservative; use oral suspension immediately after the powder is mixed in water.131

Suspension

15–30°C; avoid freezing.146

Oral

Tablets, Film-coated

15–30°C.134

Intravaginal

Tablets

15–30°C.129

Actions and Spectrum

  • Fungistatic or fungicidal in action.128 129 133 134 146

  • Binds to sterols in the fungal cell membrane, which no longer functions as a selective barrier and allows the loss of potassium and other cellular constituents.128 129 130 131 133 134 146 150

  • Active against a variety of pathogenic and nonpathogenic yeasts and fungi.128 129 133 134 146 Inactive against organisms that do not contain sterols in their cell membrane (e.g., bacteria, protozoa, viruses).128 129 133 134 146

  • Candida: Active against C. albicans, C. glabrata, C. krusei, C. parapsilosis, C. pseudotropicalis, C. guilliermondi, and C. tropicalis.128 133 e

  • Dermatophytes: Active against Trichophyton rubrum and T. mentagrophytes.128 133

  • Nystatin resistance has been reported in some strains of C. albicans, C. glabrata, C. guilliermondi, C. krusei, and C. tropicalis.128 133 134 150 e

Advice to Patients

  • Importance of not interrupting or discontinuing oral or topical nystatin therapy until the prescribed regimen is completed even though symptomatic relief may occur within a few days.128 133 e

  • Importance of not interrupting or discontinuing vaginal nystatin therapy during a prescribed regimen, even during menstruation or if symptomatic relief occurs after only a few days of therapy, unless otherwise instructed by clinician.129

  • Importance of discontinuing treatment and consulting clinician if irritation or sensitization (redness, itching, burning, blistering, swelling, oozing) occurs at the treatment site.128 129 133 e

  • Advise patients of preventive measures to prevent reinfection.130

  • Importance of instructing patient on proper preparation and use of extemporaneous oral suspensions prepared from powder for oral suspension.131 Advise patient that extemporaneously prepared oral suspensions do not contain a preservative and should be used immediately after preparation and should not be stored.131

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.e

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Nystatin

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

For suspension

50 million units*

Nystatin Powder

Paddock

Nystat-Rx

X-GEN

150 million units*

Nystatin Powder

Paddock

Nystat-Rx

X-GEN

500 million units*

Nystatin Powder

Paddock

Nystat-Rx

X-GEN

1 billion units

Nystat-Rx

X-GEN

2 billion units*

Nystatin Powder

Paddock

Nystat-Rx

X-GEN

Suspension

100,000 units/mL*

Nystatin Suspension (with ≤1% alcohol parabens and sucrose 50%)

Actavis, Fougera, Morton Grove, Taro

Tablets, film-coated

500,000 units*

Nystatin Tablets

Teva, United Research Laboratories

Topical

Cream

100,000 units/g*

Mycostatin (with propylene glycol)

Bristol-Myers Squibb

Nystatin Cream

Actavis, Fougera, Perrigo, Taro

Ointment

100,000 units/g*

Nystatin Ointment

Actavis, Fougera, Perrigo

Powder

100,000 units/g*

Mycostatin (dispersed in talc)

Bristol-Myers Squibb

Nystatin Topical Powder (dispersed in talc)

Par, Upsher-Smith

Nystop (dispersed in talc)

Paddock

Pedi-Dri (dispersed in talc)

Pedinol

Vaginal

Tablets

100,000 units*

Nystatin Vaginal Tablets (available with applicator)

Odyssey

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Nystatin Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Topical

Cream

100,000 units/g with Triamcinolone Acetonide 0.1%*

Mykacet

Actavis

Nystatin and Triamcinolone Acetonide Cream

Fougera, Taro

Ointment

100,000 units/g with Triamcinolone Acetonide 0.1%*

Mykacet

Actavis

Nystatin and Triamcinolone Acetonide Ointment

Fougera, Taro

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Nystatin-Triamcinolone 100000-0.1UNIT/GM-% Cream (TARO): 15/$29.99 or 45/$67.97

Nystatin-Triamcinolone 100000-0.1UNIT/GM-% Cream (TARO): 30/$37.99 or 60/$64.97

Nystatin-Triamcinolone 100000-0.1UNIT/GM-% Cream (TARO): 60/$49.99 or 120/$90.97

Nystatin-Triamcinolone 100000-0.1UNIT/GM-% Ointment (TARO): 15/$34.99 or 30/$59.97

Nystatin-Triamcinolone 100000-0.1UNIT/GM-% Ointment (TARO): 30/$45.99 or 60/$82.97

Nystatin-Triamcinolone 100000-0.1UNIT/GM-% Ointment (TARO): 60/$59.99 or 180/$165.97

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions July 1, 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

100. Nystatin Multicenter Study Group. Therapy of candidal vaginitis: the effect of eliminating intestinal Candida. Am J Obstet Gynecol. 1986; 155:651-5. [IDIS 221446] [PubMed 3529970]

101. Dennerstein GJ, Langley R. Vulvovaginal candidiasis: treatment and recurrence. Aust NZ J Obstet Gynaecol. 1982; 22:231-3.

102. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2006. MMWR Recomm Rep. 2006; 55(No. RR-11):1-85.

103. Holmes KK, Handsfield HH. Vulvovaginal candidiasis. In: Braunwald E, Isselbacher KJ, Petersdorf RG et al, eds. Harrison’s principles of internal medicine. 11th ed. New York: McGraw-Hill Book Company; 1987:513.

104. Velupillai S, Thin RN. Treatment of vulvovaginal yeast infection with nystatin. Practitioner. 1977; 219:897-901.

105. Milne JD, Warnock DW. Effect of simultaneous oral and vaginal treatment of the rate of cure and relapse in vaginal candidosis. Br J Vener Dis. 1979; 55:362-5. [PubMed 389354]

106. Sobel JD. Epidemiology and pathogenesis of recurrent vulvovaginal candidiasis. Am J Obstet Gynecol. 1985; 152:924-935. [PubMed 3895958]

107. Sobel JD. Pathogenesis and treatment of recurrent vulvovaginal candidiasis. Clin Infect Dis. 1992; 14(Suppl 1):S148-53.

108. Anon. Drugs for sexually transmitted diseases. Med Lett Treat Guid. 2004; 2:67-74.

109. US Public Health Service (USPHS) and Infectious Diseases Society of America (IDSA) Prevention of Opportunistic Infections Working Group. 2001 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons with human immunodeficiency virus. From HIV/AIDS Treatment Information Services (ATIS) website ().

110. MacPhail LA, Hilton JF, Dodd CL et al. Prophylaxis with nystatin pastilles for HIV-associated oral candidiasis. J Acquir Immune Defic Syndr Hum Retrovirol. 1996; 12:470-6. [PubMed 8757423]

111. Anon. Drugs for AIDS and associated infections. Med Lett Drugs Ther. 1995; 37:87-94. [PubMed 7565297]

112. American Thoracic Society. Fungal infection in HIV-infected persons. Am J Respir Crit Care Med. 1995; 152:816-22. [IDIS 352046] [PubMed 7633749]

113. Bristol-Myers Squibb. Mycostatin (nystatin lozenges) pastilles prescribing information. Princeton, NJ; 1999 Aug.

114. Munz D, Powell KR, Pai CH. Treatment of candidal diaper dermatitis: a double-blind placebo-controlled comparison of topical nystatin with topical plus oral nystatin. J Pediatr. 1982; 101:1022-5. [IDIS 162522] [PubMed 6754898]

115. Hoppe JE. Treatment of oropharyngeal candidiasis and candidal diaper dermatitis in neonates and infants: review and reappraisal. Pediatr Infect Dis J. 1997; 16:885-94. [IDIS 392887] [PubMed 9306485]

116. Hay RJ. Yeast infections. Dermatol Clin. 1996; 14:113-24. [PubMed 8821164]

117. Doering PL, Santiago TM. Drugs for the treatment of vulvovaginal candidiasis: comparative efficacy of agents and regimens. DICP. 1990; 24:1078-83. [IDIS 274670] [PubMed 2275233]

118. Sobel JD. Vaginitis. N Engl J Med. 1997; 337:1896-903. [IDIS 401347] [PubMed 9407158]

119. Sobel JD, Faro S, Force RW et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. Am J Obstet Gynecol. 1998; 178:203-11. [IDIS 402301] [PubMed 9500475]

120. Bisschop MPJM, Merkus JMWM, Scheygrond H et al. Co-treatment of the male partner in vaginal candidosis: a double-blind randomized control study. Br J Obstet Gynecol. 1986; 93:79-81.

121. Bohannon NJV. Treatment of vulvovaginal candidiasis in patients with diabetes. Diabetes Care. 1998; 21:451-6. [IDIS 402373] [PubMed 9540031]

122. Tobin MJ. Vulvovaginal candidiasis: topical vs. oral therapy. Am Fam Physician. 1995; 51:1715-24. [IDIS 348350] [PubMed 7754931]

123. Sobel JD. Controversial aspects in the management of vulvovaginal candidiasis. J Am Acad Dermatol. 1994; 31: S10-3. [IDIS 335764] [PubMed 8077494]

124. Reviewers’ comments (personal observations) on Tioconazole 84:04.08.

125. Roxane Laboratories. Nystatin oral suspension USP 100,000 USP units/mL prescribing information. Columbus, OH; 1991 Dec.

126. Powderly WG, Mayer KH, Perfect JR. Diagnosis and treatment of oropharyngeal candidiasis in patients infected with HIV: a critical reassessment. AIDS Res Hum Retroviruses. 1999; 15:1405-12. [PubMed 10555102]

127. Anon. Drugs for vulvovaginal candidiasis. Med Lett Drugs Ther. 2001; 43:3-4. [PubMed 11151090]

128. Bristol-Myers Squibb. Mycostatin (nystatin) cream and topical powder prescribing information. Princeton, NJ. April 1997.

129. Odyssey Pharmaceuticals. Nystatin vaginal tablets USP 100,000 units prescribing information. East Hanover, NJ. 2003 March.

130. Fougera. Nystatin-triamcinolone acetonide cream USP prescribing information. Melville, NY; 1989 March.

131. Paddock Laborotories, Inc. Nystatin USP for extemporaneous preparation of oral suspension prescribing information. Minneapolis, MN.

132. Hoppe JE. Treatment of oropharyngeal candidiasis and candidal diaper dermatitis in neonates and infants: review and reappraisal. Pediatr Infant Dis J. 1997; 16:885-94.

133. Paddock Laborotories, Inc. Nystop (nystatin) topical powder, USP prescribing information. Minneapolis, MN. 2003 May

134. Teva. Nystatin tablets, USP prescribing information. Sellersville, PA. 1998 Jun.

135. Williams C, Whitehouse JM, Lister TA et al. Oral anticandidal prophylaxis in patients undergoing chemotherapy for acute leukemia. Med Pediatr Oncol. 1977; 3:275-80. [PubMed 311410]

136. Carpentieri U, Haggard ME, Lockhart LH et al. Clinical experience in prevention of candidiasis by nystatin in children with acute lymphocytic leukemia. J Pediatr. 1978; 92:593-5. [IDIS 103783] [PubMed 273087]

137. Pizzuto J, Conte G, Ambriz R et al. Nystatin prophylaxis in leukemia and lymphoma. N Engl J Med. 1978; 298:279-80. [PubMed 619271]

138. Wade JC, Schimpff SC, Hargadon MT et al. A comparison of trimethoprim-sulfamethoxazole plus nystatin with gentamicin plus nystatin in the prevention of infections in acute leukemia. N Engl J Med. 1981; 304:1057-62. [IDIS 130741] [PubMed 6782486]

139. Groll AH, Just-Nuebling G, Kurz M et al. Fluconazole versus nystatin in the prevention of candida infections in children and adolescents undergoing remission induction or consolidation chemotherapy for cancer. J Antimicrob Chemother. 1997; 40:855-62. [IDIS 399161] [PubMed 9462438]

140. Lumbreras C, Cuervas-Mons V, Jara P et al. Randomized trial of fluconazole versus nystatin for the prophylaxis of Candida infection following liver transplantation. J Infect Dis. 1996; 174:583-8. [IDIS 374439] [PubMed 8769617]

141. Hughes WT, Armstrong D, Bodey GP et al. 1997 guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. Clin Infect Dis. 1997; 25:551-73. [IDIS 393722] [PubMed 9314442]

142. Reviewers’ comments (personal observations) on fluconazole 8:14.08.

143. Edwards JE, Bodey GP, Bowden RA et al. International conference for the development of a consensus on the management and prevention of severe candidal infections. Clin Infect Dis. 1997; 25:43-59. [IDIS 387869] [PubMed 9243032]

144. Walsh TJ, Lee JW. Prevention of invasive fungal infections in patients with neoplastic diseases. Clin Infect Dis. 1993; 17(Suppl 2):S468-80. [IDIS 323669] [PubMed 8274613]

145. Perfect JR. Antifungal prophylaxis: to prevent or not. Am J Med. 1993; 92:233-4.

146. Alpharma. Nystatin oral suspension, USP 100,000 units per mL prescribing information. Baltimore, MD. 1996 Sept.

147. Alpharma. Nystatin cream, USP (100,000 units/g) prescribing information. Baltimore, MD. 2000 Nov.

148. Alpharma. Nystatin ointment, USP (100,000 units/g) prescribing information. Baltimore, MD. 2000 Nov.

149. Edwards JE, Jr. Candida species. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 5th ed. New York: Churchill Livingstone; 2000: 2656-74.

150. Kucers A, Crowe S, Grayson ML et al, eds. The use of antibiotics. A clinical review of antibacterial, antifungal, and antiviral drugs. 5th ed. Jordan Hill, Oxford: Butterworth-Heinemann; 1997: 1295-300.

e. AHFS Drug Information 2004. McEvoy GK, ed. Nystatin. American Society of Health-System Pharmacists; 2004:3363-6.

i. AHFS Drug Information 2003. McEvoy GK, ed. Topical Corticosteroids Statement. American Society of Health-System Pharmacists; 2003:page 3403-6.

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