Nystatin is a polyene antifungal agent with broad-spectrum antifungal effect, but it is not absorbed through skin and mucosa. After oral administration, the concentration of Nystatin in blood is very low. It is only used locally in clinic and the curative effect is not satisfactory. According to the literature, its new formulation not only improves the effect of topical application, but also enlarges its use.
1 Nystatin liposome injection was developed by Aronex and is at the end of phase III clinical trial.
109 patients with candidemia were treated by intravenous administration of 2 mg/kg daily in 91 cases and 4 mg/kg in 18 cases. The average course of treatment was 10.6 days. Among 56 patients, 50 were effective. 60% of Candida infections with low clinical immunity were sensitive to amphotericin B or fluconazole, and 80% of patients were cured by intravenous administration.
24 patients with invasive aspergillosis who could not tolerate amphotericin B or were ineffective in treatment of aspergillosis were treated with this product. Intravenous drip of 4 mg/kg was given daily, and 6 of 19 patients could be evaluated as effective.
In the treatment of cryptococcal meningitis, the efficacy of intravenous administration of 4 mg/kg of this product per day was similar to that of amphotericin B 0.7 mg/kg per day.
27 patients with recurrent fever associated with agranulocytosis were treated with this product for 8 days, of which 10 (37%) achieved satisfactory clinical results.
Adverse reactions
Common adverse reactions were hypokalemia (25%) and renal impairment (which might occur when the daily dose was more than 6 mg/kg). Quick intravenous drip may cause chills, fever, dyspnea, occasional rashes, liver function damage, but usually does not affect treatment, no need to stop medication.
Each tablet containing nystatin 100,000 U was used to treat 120 cases of simple vulvovaginal candidiasis, aged 20-50 years. Two tablets per day were used for one week. Before the treatment, 2%-4% sodium bicarbonate was used to clean the vulva. The total effective rate was 93.3%. There was no significant difference between the two groups.
Nystatin glycerin coating
Neonatal thrush patients were male newborns. After 15 days of antibiotic treatment for pneumonia, flakes of white milk appeared on the oral mucosa and tongue, and nystatin tablets and nystatin water suspension were taken orally for 15 days. The symptoms were mild or severe. The affected area was coated with nystatin 100,000 U/ml glycerol three times a day. It recovered after 2 days and did not recur. Jiang reported that 69 children were treated with this product for a minimum of 42 days and a maximum of 9 months. The total effective rate was 70%, which was significantly better than that of the control group using Zhuhuang powder.
67 cases of fungal stomatitis were treated in this group, including 42 males and 25 females. The oldest was 76 years old and the youngest was 4 years old. The clinical manifestation was that oral mucosa was covered with white pseudomembranes. The heavier cases were covered with white pseudomembranes on both cheeks, hard palate, gingiva and tongue. Therapeutic methods: First, clean the mouth with 2%~4% sodium bicarbonate solution, then apply nystatin glycerin to the affected area, 3~4 times a day, light 4~5 days, heavy 10 days can be cured.
Nystatin paste
In the treatment of mycotic vaginitis, nystatin tablets were ground into fine powder and mixed with skin care cream for children to make paste. Firstly, the affected area was cleaned with 5% sodium bicarbonate solution, and the paste was applied with a cotton swab. The thickness of the paste was 1 mm, once a day, and it could be cured in 3-7 days.