Nystatin

INTRODUCTION

Indications

Cream, powder: Treatment of a variety of cutaneous fungal infections, including cutaneous candidiasis, tinea pedis (athlete's foot), tinea cruris (jock itch), tinea corporis (ringworm), and tinea versicolor. Lozenges, oral suspension: Local treatment of oropharyngeal candidiasis. Treatment of intestinal candidiasis.

Vaginal tablets: Treatment of vulvovaginal candidiasis.

Action

Affects the permeability of the fungal cell wall, allowing leakage of cellular contents. Therapeutic Effects: Decreased symptoms of fungal infection.

Adverse Reactions/Side Effects

Local: burning, itching, local hypersensitivity reactions, redness, stinging. GI: diarrhea, nausea, stomach pain (large doses), vomiting. Derm: contact dermatitis, Stevens-Johnson syndrome. GU: irritation, sensitization.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor symptoms and healing of skin lesions to help document drug effectiveness.

• Notify physician immediately of severe rashes or dermatitis because certain conditions may indicate serious hypersensitivity reactions (e.g., Stevens-Johnson syndrome).

Interventions

• Avoid contact with cutaneous lesions when treating patient.

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection.

Patient/Client-Related Instruction

• Advise patient to report any increased local sensitivity to this drug (pain, burning, itching, swelling).

• Instruct patient about proper hygiene; e.g., thoroughly wash and dry the affected area, wear clean socks and ventilated shoes for tinea pedis, and so forth.

• Advise patient to apply the drug as directed for the full course of treatment, even if feeling better.

• Inform patient that early relief of cutaneous symptoms may be seen in 2–3 days. Full therapeutic response may take 2 wk for cutaneous candidiasis, tinea cruris, tinea versicolor, and tinea corporis, and 6 wk for tinea pedis.

• Vaginal infections: therapeutic response is usually seen after 1 wk. Therapy should be continued during menstrual period.

• Instruct patient to notify physician of severe or prolonged GI effects (nausea, vomiting, diarrhea) during oral administration.

• Advise patient to seek medical help if infections persist or recur after the full treatment. Recurrent fungal infections may be a sign of systemic illness.

Pharmacokinetics

Absorption: Absorption through intact skin is minimal.

Distribution: Distribution after topical administration is primarily local.

Metabolism and Excretion: Systemic metabolism and excretion is negligible with local application.

Half-life: Not applicable.