Polyene antifungal antibiotic
ATC code: A07AA02 (Nystatin)
Binds ergosterol in fungal cell membranes, creates pores, disrupts osmotic balance. Fungicidal against Candida albicans, C. glabrata, C. tropicalis. Not absorbed from the GI tract – no systemic action. Topically also not absorbed.
First line
Nipple and milk duct candidiasis. Per ABM Protocol 26 2022 and AEPED 2023, topical cream or suspension to nipples 4 times daily after feeds for 14 days. Simultaneously to the infant – oral suspension 100,000 IU/mL, 1 mL 4 times daily for 14 days. Without simultaneous mother-infant treatment, recurrence is inevitable.
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Safe in pregnancy (topical or oral without systemic absorption).
Fully compatible. Hale L1. Not absorbed from GI tract or skin – no infant systemic exposure. Drug of choice for nipple candidiasis alongside infant treatment.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Nystatin is evaluated for the following indications with varying evidence strength: Nipple candidiasis during lactation (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of Nystatin (≥ 1 in 100): Local irritation (rare), Nausea with oral use (rare). See the Safety section for uncommon and serious reactions.
FDA category C. Safe in pregnancy (topical or oral without systemic absorption).
Fully compatible. Hale L1. Not absorbed from GI tract or skin – no infant systemic exposure. Drug of choice for nipple candidiasis alongside infant treatment.
Nystatin is contraindicated in: Hypersensitivity to nystatin. Full list in the Safety section.