![]() ![]() The quality of the included studies was assessed using the Cochrane Handbook for Systematic Review of Interventions and the Rev Man 5.2.0 software. All the relevant data of each included study, including author, year of publication, region, risk factors, characteristics of the patients, detailed interventions, outcomes, and adverse effects, were extracted and summarized in a table format. The two review authors (XL, CZ) were independently responsible for scanning titles and abstracts, selecting studies, reading full reports, extracting data, and assessing the quality of studies these steps were performed in duplicate by each of these authors. The aim of this study was to summarize and assess the efficacy, different treatment protocols (formulation, dosage, and duration), and safety of nystatin in different patient populations with oral candidiasis by a meta-analysis and systematic review. 5, 21– 23 Up to now, there is no consensus on the formulation, dosage, or treatment duration of nystatin in the treatment of oral candidiasis. 18, 20 Treatment duration can vary from 1 or 2 to 4 weeks. 16– 19 The common recommended dose for topical use of nystatin is 200,000–600,000 IU qid for children and adults, and 100,000–200,000 IU qid for newborns and infants. Further, nystatin also plays an important role in the prophylaxis of oral and systemic candidiasis in full-term and premature newborns, infants, and immunocompromised patients (eg, AIDS patients, cancer patients, and organ transplant recipients), as it is associated with a low incidence of drug interactions and acceptable costs, especially in developing countries. ![]() 5 Therefore, the topical use of nystatin is considered the most common route of administration in dentistry, as systemic exposure is minimal. ![]() 11– 15 Nystatin is not absorbed from gastrointestinal tract when orally administered. Nystatin is a membrane-active polyene macrolide produced by Streptomyces noursei strains and is available in various forms, such as oral suspension, topical cream, and oral pastille. 7, 8 Topical antifungal agents, such as nystatin, amphotericin B, miconazole, and clotrimazole, are recommended typically as the first-line treatment for uncomplicated cases of oral candidiasis. 3, 6 However, numerous drug interactions and decreased susceptibility of species other than Candida albicans toward azoles limit the application of systemic antifungal agents. 3 Systemic antifungal agents, including triazoles, fluconazole, and itraconazole, are appropriate for patients who do not respond to or are intolerant to topical treatment and those at high risk of developing systemic infections. Various topical and systemic agents are currently available for the treatment of oral candidiasis. 3– 5 Elimination of the predisposing factors is an important strategy in treating oral candidiasis. 1, 2 It has been associated with multiple host risk factors, including impaired salivary gland function, denture wearing, oral mucosa disruption, drug use (long-term administration of broad-spectrum antibiotics, corticosteroids, antidepressants, antineoplastic, drugs, and immunosuppressant), age (common in neonates and the elderly), endocrine alterations (diabetes mellitus, pregnancy, renal failure, and hyperthyroidism), dietary factors (high-carbohydrate diet and iron-deficiency anemia), cancer, and HIV infection. Oral candidiasis, which is the most common human fungal infection, is characterized by an overgrowth of Candida species in the superficial epithelium of the oral mucosa. ![]()
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