September 28th 2001

Oral Nystatin for anal/prostatic infections ?

I recently took some Nystatin (400,000 units, 1 dose oral), for anal itching and tenderness (suspected candida infection). Paradoxically the anal condition showed little improvement but a pre-existing chronic urethral/prostate problem improved a great deal. I'm very surprised since Nystatin isn't supposed to be absorbed via the gut.

I was put on a course of Nystatin 500,000units 4/day for 10 days. Since I had previously had marked reaction to anti-fungal ointments applied to the anus (Clotrimazole, miconazole nitrate, ?tibrufen?), I took only a partial dose (400,000) and waited to see what the effects were. I got severe anal stinging with BMs with the Nystatin in, felt cold and shivery, increased but shallow pulse rate, confused and irritated for 3-6 hours. This is very similar to the reactions I had with the other AFs.  Is this mild shock?

The increased anal irritation subsided about 24 hrs after 1st Nystatin BM.

Subsequently the anal itching seemed slightly improved.

Most markedly though for 4-5 days after the single Nystatin dose the following 3yr long symptoms almost disappeared:
1. Pain/ discomfort in meatus/urethra on urinating and sexual stimulation esp ejaculating.
2. Large yellow gelatinous lumps in semen
3. Partial stenosis of urethral opening.
However these symptoms are gradually returning (now 10 days after)

Any explanations or similar experiences ?

My personal "theory" is:
I have a candida infection (systemic or at a number of sites including anus/prostate/urethra). Nystatin is absorbed locally from the ano-rectal tissues into surrounding structures including prostate.
Nystatin is excreted in the prostatic fluid, decontaminating the urethra.
Is this plausible ?
Has anyone heard of oral nystatin prescribed for eg. prostate conditions ?

Pharmacological Questions:

1. Should I continue taking the Nystatin given my level of reaction ? e.g I don't see any way I could tolerate more than 1x500,000u/day max
2. What other anti-fungals if any should I consider taking ? I seem to get allergic reaction to all AFs in my anal area.
3. Is this reaction normal ?
3b Is this likely a local reaction or because the AFs are beings absorbed systemically from the anus ?
4. Am I risking developing hypersensitivity to all AFs if I continally try out different ones?
5. Is it worth hanging on for "better " AFs eg. lipid forms of Nystatin (Nizoral)and Ampothericin B, which I understand are in PhaseIII trials ?

I found and the rest of the site to be an excellent AF resource.

Feedback appreciated.