Treatment of cutaneous infections caused by Candida, including perlèche, intertriginous candidiasis, and paronychia. Used topically alone or in fixed combination with a corticosteroid (triamcinolone acetonide).
Treatment of candidal diaper dermatitis. Treatment of choice is a topical antifungal (e.g., nystatin, clotrimazole, miconazole); may be used in conjunction with a topical corticosteroid. 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. Some clinicians recommend that an oral antifungal agent (e.g., oral nystatin) be administered concomitantly to treat the intestinal infection, but studies have not provided evidence that concomitant oral and topical therapy is more effective than topical therapy alone.
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. Some clinicians prefer to use systemic oral azole antifungals for initial therapy of oropharyngeal candidiasis in HIV-infected individuals.
Nystatin is ineffective for treatment of esophageal candidiasis in HIV-infected individuals.
Intestinal Candidiasis
Oral treatment of mucous membrane (nonesophageal) GI candidiasis.
Has been used orally in conjunction with an intravaginal antifungal to treat coexisting intestinal candidiasis and vulvovaginal candidiasis. (See Vulvovaginal Candidiasis under Uses.)
Vulvovaginal Candidiasis
Treatment of vulvovaginal candidiasis. 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. Intravaginal nystatin can be used for uncomplicated vulvovaginal candidiasis, but generally is less effective than intravaginal azole antifungals.
Has been used orally in conjunction with an intravaginal antifungal to treat coexisting intestinal candidiasis and vulvovaginal candidiasis. 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, most evidence suggests that combined oral and intravaginal therapy does not substantially reduce the risk of recurrence compared with intravaginal therapy alone.
Topical treatment of male sexual partners of women with recurrent vulvovaginal candidiasis who have symptomatic balanitis or penile dermatitis. 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.
Prevention of Candida Infections
Oral nystatin has been used for prevention of initial or recurrent mucocutaneous candidiasis (including oropharyngeal candidiasis) in HIV-infected individuals†, 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). 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.
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). 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). If primary prophylaxis against candida infections is used in cancer or transplant recipients, many clinicians recommend oral fluconazole.
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