title: Efficacy of nystatin for the treatment of oral candidiasis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To systematically review and assess the efficacy, different treatment protocols (formulation, dosage, and duration), and safety of nystatin for treating oral candidiasis.
  
  
  METHODS
  Four electronic databases were searched for trials published in English till July 1, 2015. Randomized controlled trials comparing nystatin with other antifungal therapies or a placebo were included. Clinical and/or mycological cure was the outcome evaluation. A meta-analysis or descriptive study on the efficacy, treatment protocols, and safety of nystatin was conducted.
  
  
  RESULTS
  The meta-analysis showed that nystatin pastille was significantly superior to placebo in treating denture stomatitis. Nystatin suspension was not superior to fluconazole in treating oral candidiasis in infants, children, or HIV/AIDS patients. The descriptive investigations showed that administration of nystatin suspension and pastilles in combination for 2 weeks might achieve a higher clinical and mycological cure rate, and using the nystatin pastilles alone might have a higher mycological cure rate, when compared with using nystatin suspensions alone. Nystatin pastilles at a dose of 400,000 IU resulted in a significantly higher mycological cure rate than that administrated at a dose of 200,000 IU. Furthermore, treatment with nystatin pastilles for 4 weeks seemed to have better clinical efficacy than treatment for 2 weeks. Descriptive safety assessment showed that poor taste and gastrointestinal adverse reaction are the most common adverse effects of nystatin.
  
  
  CONCLUSIONS
  Nystatin pastille was significantly superior to placebo in treating denture stomatitis, while nystatin suspension was not superior to fluconazole in treating oral candidiasis in infants, children, or HIV/AIDS patients. Indirect evidence from a descriptive study demonstrated that administration of nystatin pastille alone or pastille and suspension in combination is more effective than that of suspension alone; prolonged treatment duration for up to 4 weeks can increase the efficacy of nystatin. More well designed and high quality randomized control studies are needed to confirm these findings.
authors.affiliation: Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China.
authors.forename: Xin
authors.initials: X
authors.lastname: Lyu
authors.affiliation: Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China.
authors.forename: Chen
authors.initials: C
authors.lastname: Zhao
authors.affiliation: Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China.
authors.forename: Zhi-Min
authors.initials: ZM
authors.lastname: Yan
authors.affiliation: Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China.
authors.forename: Hong
authors.initials: H
authors.lastname: Hua
mesh_terms: D002180:Candidiasis, Oral / Q000188:drug therapy* / Q000382:microbiology; D004305:Dose-Response Relationship, Drug; D006801:Humans; D009761:Nystatin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D009761:Nystatin
keywords: dosage forms; meta-analysis; nystatin; oral candidiasis; safety; systematic review; treatment duration