Nystatin dosing

Nystatin has a specific action on C. albicans and is of no value in the treatment of any other type of infection. It is poorly absorbed from the gastrointestinal tract even after very large doses, the blood level is insignificant. It is administered orally in the treatment of oral thrush and intestinal candidiasis infections. 

Prophylaxis Nystatin, clotrimazole, Inhibit P-450 3A4 monitor CSA and TAC levels decrease doses... 

Pharmaceutical powder is a mixture of finely divided drugs and/or chemicals in dry form. They are dispensed as bulk powders or divided powders. When the prescription is received for powders, first determine whether it is based upon one unit or upon a bulk formula to be subdivided into individual units. Bulk powders are provided as multiple doses in a container and the patient measures the dose as instructed at the time of administration. Some examples of bulk powders include Tolnaftate Powder USP and Nystatin Topical Powder USP as antifungals, and Desitin Powder for diaper rash. Divided powders are meant to be provided as single dose units in individually wrapped powder papers. Such single dose packets are stacked in a powder box, and the label... 

Triamcinolone Nystatin (Mycolog ) [Anti-inflammatory Antifungal/Corticosteroid] Uses Cutaneous candidiasis Action Antifungal anti-inflammatory Dose Apply lightly to area bid max 25 mg/d Caution [C, ] Contra Varicella systemic fungal Infxns Disp Cream oint SE Local irritation, hypertrichosis, pigmentation changes Interactions T Effects W/barbiturates, phenytoin, rifampin T effects OF salicylates, vaccines EMS See Triamcinolone OD See Triamcinolone... 

Fluconazole is very effective in the treatment of infections with most Candida spp. Thrush in the end-stage AIDS patient, often refractory to nystatin, clotrimazole, and ketoconazole, can usually be suppressed with oral fluconazole. AIDS patients with esophageal candidiasis also usually respond to fluconazole. A single 150-mg dose has been shown to be effective treatment for vaginal candidiasis. A 3-day course of oral fluconazole is effective treatment for Candida urinary tract infection and is more convenient than amphotericin B bladder irrigation. Preliminary findings suggest that Candida endophthalmitis can be successfully treated with fluconazole. Stable nonneutropenic patients with candidemia can be adequately treated with fluconazole, but unstable, immunosuppressed patients should initially receive... 

Absorption of nystatin from the gastrointestinal tract is negligible, and the drug appears in feces. In turkeys and chickens, dietary dosing with nystatin resulted in residue concentrations below 2,500 ppb in muscle, liver, kidney, fat, and skin, and below 500 ppb in blood. In laying hens, dietary dosing with nystatin resulted in residue concentrations in eggs below 500 ppb of the parent compound. 

A 41-year-old woman, with liver lacerations, rib fractures, and pneumothorax after a motor vehicle accident, was given haloperidol for agitation on day 7. During the first 24 hours she received a cumulative intravenous dose of 15 mg, 70 mg on day 2, 190 mg on day 3,160 mg on days 4 and 5, and 320 mg on day 6. An hour after the first dose of 80 mg on day 7, she had ventricular extra beats followed by 5-beat and 22-beat runs of ventricular tachycardia. The rhythm strips were consistent with polymorphous ventricular tachycardia or torsade de pointes and the QTC interval was 610 ms (normally under 450 in women). She received intravenous magnesium sulfate 2 g. Concurrent medications included enoxaparin, famotidine, magnesium hydroxide, ampicillin/sulbactam, nystatin suspension, midazolam, and 0.45% saline with 20 mmol/1 of potassium chloride. She had no further dysrhythmias after haloperidol was withdrawn. Eight days after the episode of torsade de pointes she had a QTC interval of 426 ms. 

A mouth that is dry and painful may be due to candidiasis (treat with nystatin), to dehydration (rehydrate the patient judiciously where this can be done orally) the symptom can be managed by frequent small drinks or crushed ice to suck (plus assiduous mouth hygiene to prevent unpleasant infection) if due to antimuscarinic drugs, including some antidepressants, withdraw the drug or adjust its dose. 

In 34 otherwise healthy infants with oral candidiasis randomized to either nystatin oral suspension qds for 10 days or fluconazole suspension 3 mg/kg in a single daily dose for 7 days, 6 of 19 were cured by nystatin and all of 15 by fluconazole (67). Fluconazole was tolerated without apparent adverse events. 

An intravenous multilamellar liposomal formulation of nystatin has been developed. Its pharmacokinetics are unique among polyenes and are characterized by high peak plasma concentrations and a rapid clearance rate. In a phase I study it was tolerated well at doses up to 8 mg/kg. It was efficacious in candidemia, invasive aspergillosis, and as empirical antifungal therapy in patients with cancer and neutropenia (1). However, it was subsequently withdrawn by the manufacturers. 

Topical therapy with clotrimazole or nystatin for 7 days is usually adequate for treating mucocutaneous candidiasis in most solid-organ transplant patients. Use of topical therapy will reduce the number of systemic drugs that these patients receive and hence minimize the risk of drug-drug interactions. Failure to respond to topical agents warrants the use of fluconazole. Low-dose amphotericin B 5-10 mg daily for 7 to 10 days is reserved for the unusual cases of treatment failure. 

An oral suspension that contains 100,000 units/ml of nystatin is given fom times a day. Premature and low-birth-weight neonates should receive 1 mL of this preparation, infants 2 mL, and children or adults 4 to 6 mL per dose. Older children and adults should be instructed to swish the drug around the mouth and then swallow. If not otherwise instructed, the patient may expectorate the bitter liquid and fail to treat the infected mucosa in the posterior pharynx or esophagus. Nystatin suspension is usually effective for oral candidiasis of the immunocompetent host. Other than the bitter taste and occasional complaints of nausea, adverse effects are uncommou. A 200,000-unit troche (mycostatin pastilles) is available for the treatment of oral candidiasis, and a 500,000-unit oral tablet is sold for the treatment of nonesophageal membrane G1 candidiasis. 

Clotrimazole and nystatin may he used topically (not orally) for vaginal candidiasis. The activity of griseofulvin is limited to dermatophytes. Huconazole in a single ortd dose is usually effective in vaginal candidiasis. The answer is (C). 

Nystatin is used therapeutically in veterinary medicine as an otic product for companion animals. There is very little toxicity data either in humans or in animals available for this drug but it does appear to be maternotoxic, at least when formulated as a liposomal product, at doses of 3.0mg/kgbw/day in rats and rabbits. However, it was not teratogenic and it had no effects on reproductive parameters at doses below the maternotoxic dose. It was not ototoxic in a chinchilla model. " ... 

A tablet containing 500 000 units of nystatin. Adult dose 500 000-1 000 000 units every 6 hours. 

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