Dr Sharon Rees @reesprescribe
Day 1: Discovered via painstaking screening of soil samples in 1950 by Elizabeth Lee Hazen and Rachel Fuller Brown, #nystatin is a mixture of antifungal polyenes derived from the bacteria Streptomyces noursei. From the hundreds of cultures tested, the species was discovered in the garden of a friend, surname Nourse! #nystatin is so-called because the women worked at the New York State Dept of Health.
Dr Sharon Rees @reesprescribe
Day 2: #nystatin is a broad spectrum anti-fungal used for oral cavity candida infections. Oral suspension 1 ml (100 000 units) is dropped into the mouth after food four times daily for 7 days; Half the dose to each side of the mouth. Usually, second line to miconazole/used when miconazole is not suitable. #nystatin can be used to soak dentures overnight to prevent recurrence of oro-pharangeal thrush, in conjunction with miconazole/fluconazole treatment.
Dr Sharon Rees @reesprescribe
Day 3: #nystatin suspension is rinsed around and held in the mouth for as long as possible before spitting out. It should be continued for 48 hrs after lesions resolve. #nystatin is also added to some steroid, antiseptic and antibiotic creams for a Candida component of skin infections. Used in all age groups, but unlicensed in UK for neonates.
Dr Sharon Rees @reesprescribe
Day 4: #nystatin is used topically, but if swallowed, there is no apparent absorption from the gut. Not used parenterally re high systemic toxicity. It is possible for a low concentration to enter systemic circulation, especially if inflammatory damage. Excreted unchanged in faeces. Unknown effects in pregnancy/lactation, so only used if benefits outweigh risks.
Dr Sharon Rees @reesprescribe
Day 5: #nystatin mechanism of action. #nystatin binds preferentially to ergosterol in the cell membrane and forms a channel. This causes a change in cell permeability, leading to K+ leakage, followed by fungal cell lysis/death.
Dr Sharon Rees @reesprescribe
Day 6: Adverse drug effects; #nystatin can cause nausea, vomiting, diarrhoea, GI irritation. Rare; rash, SJS and hypersensitivity. As it contains sucrose, can affect some intolerance/malabsorption syndromes, as well as diet and diabetic control; also high in sodium (NOT exhaustive).
Dr Sharon Rees @reesprescribe
Day 7: #nystatin has no drug-drug interactions! There is little reported about resistance, but always important to use as directed. #nystatin is not usually used for prophylaxis in high-risk patients, to minimise development of anti-fungal resistance. An oral agent eg fluconazole and antiseptic mouthwash can be used.
Further reading on #nystatin
- Antifungals, systemic use: https://bnf.nice.org.uk/treatment-summary/antifungals-systemic-use.html
- Nystan Oral Suspension (Ready-Mixed): https://www.medicines.org.uk/emc/product/408/smpc
EARN YOUR CPD CERTIFICATE
With the help of Prescribing and Therapeutics Training Ltd and the Journal of Prescribing Practice, you can earn your 1-hour CPD certificate
Complete the additional reading suggested below and then answer the ten questions.
Please submit the answers to reesprescribe@gmail.com as a numbered list with TRUE/FALSE or the correct A, B, C, D option.
If you achieve 8 or more out of ten on the questions, a CPD certificate will be emailed to you.
Nystatin is a narrow spectrum anti-fungal drug
TRUE or FALSE?
Nystatin can be used in all age groups
TRUE or FALSE?
Nystatin should be continued for 12 hours after oral thrush has resolved
TRUE or FALSE?
The primary use for nystatin is:
- Vaginal thrush
- Oral candidiasis
- Oesphageal aspergillosis
- Venous ulcer infections
Nystatin is not known to be harmful in lactation, but caution is required
TRUE or FALSE?
Which of the following best describes the mechanism of action?
- Nystatin dismantles ergosterol structure
- Nystatin interferes with ergosterol production
- Nystatin attaches to ergosterol and creates ‘pores’ which cause cell content leakage
- Nystatin inhibits the cell transport of ergosterol
Which of the following is a common adverse drug effect?
- Diarrhoea
- Hypersensitivity
- Constipation
- Hepatotoxicity
There is a caution with this drug if someone has diabetes mellitus
TRUE or FALSE?
There is growing resistance to nystatin in the UK
TRUE or FALSE?
There are no drug-drug interactions for nystatin
TRUE or FALSE?
Further reading on ##nystatin
- Antifungals, systemic use: https://bnf.nice.org.uk/treatment-summary/antifungals-systemic-use.html
- Nystan Oral Suspension (Ready-Mixed): https://www.medicines.org.uk/emc/product/408/smpc