Comparitive evaluation on nystatin pastille and clotrimazole troche for the treatment of candidal stomatitis in immunocompromised patients

Nystatin has been recently reformulated as an anise-flavored soft troche (pastille) that provides higher sustained salivary concentrations than a comparable dose of the oral suspension. Eighty-six patients with presumed oropharyngeal candidiasis were treated over a period of 16 months at five participating medical centers by random, prospective, equal assignment to one of three regimens administered five times daily for 14 days: one nystatin pastille (200,000 units); two nystatin pastilles (400,000 units); or one clotrimazole troche (10 mg). Sixty-eight patients with confirmed oropharyngeal candidiasis returned at least once for evaluation. Thirty-three patients had an underlying malignancy and 26 patients had acquired immunodeficiency syndrome [AIDS]/presumed AIDS. All three regimens were equivalent in achieving healing of oral lesions following 14 days of therapy. At ten days posttherapy, the higher nystatin pastille dose was associated with the greatest rates of healing of oral lesions and of eradication of oropharyngeal Candida.