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Nystatin vs Econazole
Introduction
For patients with fungal infections, certain drugs that interfere with the cell membranes of fungi can help in eradicating the infection and managing symptoms. Nystatin and Econazole are two such drugs that are prescribed for this purpose. They both impact the integrity of fungal cell membranes but achieve this through different mechanisms. Nystatin is a polyene antifungal medication which binds to sterols in the fungal cell membrane leading to changes in membrane permeability and eventual death of the fungus. Econazole, on the other hand, is classified as an azole antifungal medication; it inhibits ergosterol biosynthesis, a vital component of fungal cell membranes, thereby disrupting their function and growth.
Nystatin vs Econazole Side By Side
| Attribute | Mycostatin | Spectazole |
|---|---|---|
| Brand Name | Mycostatin | Spectazole |
| Contraindications | Should not be used if allergic to any of its ingredients. Not meant for ophthalmic use. Pregnant women or those planning to become pregnant should consult their healthcare provider. | Should not be used if allergic to any of its ingredients. Avoid contact with eyes. Prolonged use of topical steroids can lead to skin thinning or adrenal suppression. Pregnant women or those planning to become pregnant should consult their healthcare provider. |
| Cost | Prices range from about $10 for 30g topical powder up to around $50 for oral suspension. This equates to anywhere from under a dollar up to several dollars per day. | Generally cheaper than its branded counterpart with costs typically falling between one and two dollars per day. |
| Generic Name | Nystatin | Econazole |
| Most Serious Side Effect | Difficulty breathing, which could be a sign of a severe allergic reaction; swelling in your face or throat; fever with sore throat; reddening of the eyes with pain or swelling; fast heartbeat, chest pain, shortness of breath, dizziness; effects on the nervous system like muscle rigidity, high fever, confusion, and tremors. | Signs of an allergic reaction such as hives, itching, difficulty breathing or swelling in your face or throat; severe skin reactions like burning sensation, redness, blistering or peeling skin; unusual changes in mood or behavior; vision disturbances; rapid heartbeat. |
| Severe Drug Interactions | Not specifically mentioned, but always consult with a healthcare provider for potential interactions. | Not specifically mentioned, but always consult with a healthcare provider for potential interactions. |
| Typical Dose | Topical applications are typically applied to the affected area twice daily, with a sufficient amount to cover the entire infected region. For severe or persistent infections, treatment may need to continue for several weeks. | 1% cream or solution applied topically to the affected area once daily. The treatment may be continued for up to four weeks, depending on the severity and response to the medication. For some infections, it might be necessary to apply Econazole twice daily. |
What is Nystatin?
Nystatin (the generic name for Mycostatin) was the first polyene antifungal medication, which marked a significant advancement from the previous class of antifungal drugs. Nystatin was initially approved by the FDA in 1954. Mycostatin works against fungal infections by binding to sterols in the fungal cell membrane, leading to a change in membrane properties and ultimately cell death. It is prescribed for treating various forms of candida infections.
On the other hand, Econazole (commonly sold under brand names such as Spectazole), an azole class antifungal drug, inhibits ergosterol synthesis that results in increased cellular permeability causing leakage of essential components leading to cell death. This makes it effective against a broader range of fungi compared with nystatin.
While both these medications are used for similar purposes, they differ significantly in their mechanism of action and spectrum of activity - Nystatin primarily affects Candida species while Econazole has broader effects on multiple types of fungus including dermatophytes and Candida species.
What conditions is Nystatin approved to treat?
Nystatin is prescribed to manage various fungal infections:
- Candida Infections: These include thrush (oral candidiasis), yeast infections of the skin, diaper rash caused by yeast infection, and vaginal yeast infections.
- Intestinal Candidiasis: Nystatin can be used as a preventive measure for those at risk.
Econazole, on the other hand, is primarily indicated for topical treatment of:
- Tinea Pedis: Commonly known as athlete's foot
- Tinea Cruris: Also known as jock itch
- Tinea Corporis: Ringworm of the body. It can also treat cutaneous candidiasis and tinea versicolor, conditions caused by different types of fungi.
How does Nystatin help with these illnesses?
Nystatin works to fight fungal infections by binding to sterols in the fungi cell membrane, which leads to leakage of cellular contents and ultimately death of the fungus. This process disrupts the structure and function of fungal cells, hence stopping their growth or killing them outright. It's particularly effective against Candida species, a type of yeast that can cause various infections in humans.
Alternatively, econazole interferes with fungal growth by inhibiting an enzyme necessary for synthesizing ergosterol, an important component of fungal cell membranes. Without adequate ergosterol, the cell membrane becomes permeable and dysfunctional leading to leakage and eventual death of the fungus.
Both Nystatin and Econazole are antifungal drugs but they work differently at a cellular level. Understanding these differences helps healthcare providers select appropriately between these two medications depending on what specific kind of infection needs treatment.
What is Econazole?
Econazole, sold under the brand name Spectazole among others, is an azole antifungal medication. It works by inhibiting the synthesis of ergosterol, a critical component of fungal cell membranes. This disruption in production leads to increased cellular permeability causing leakage and eventual death of the fungus. Econazole was first approved by the FDA in 1982.
Unlike Nystatin which is primarily used for treating intestinal candidiasis and oral thrush, Econazole can be used for a wide range of fungal infections including athlete's foot, ringworm, jock itch, and several yeast infections. Its side-effect profile also differs from that of nystatin; it causes less irritation and has fewer gastrointestinal side effects like diarrhea or nausea (common side effects with Nystatin). The broad-spectrum antifungal activity can be beneficial especially for patients who do not respond well to other topical antifungals such as Nystatin.
What conditions is Econazole approved to treat?
Econazole is an antifungal medication that has been approved by the FDA for the treatment of:
- Cutaneous candidiasis, a skin infection caused by Candida fungus
- Tinea pedis, also known as athlete's foot
- Tinea cruris, commonly referred to as jock itch
- Tinea corporis or ringworm infections on the body.
It effectively treats these conditions by inhibiting the growth and reproduction of fungal cells in your body.
How does Econazole help with these illnesses?
Econazole is a broad-spectrum antifungal medication that works by inhibiting the synthesis of ergosterol, a vital component in fungal cell membranes. This disruption leads to increased cellular permeability causing leakage of nutrients and subsequent fungicidal action. It's most commonly used topically for skin infections such as athlete's foot, tinea, candidiasis etc., but can also be used against systemic mycoses. Econazole tends to be more effective than Nystatin for certain types of fungus due to its broader spectrum capabilities. While both drugs function as antifungals, Econazole might be preferred when dealing with harder-to-treat fungal strains or those not responding well to typical antifungals like Nystatin. However, it should always be prescribed under medical supervision considering potential side effects and drug interactions.
How effective are both Nystatin and Econazole?
Both nystatin and econazole have long-standing records of effectively treating fungal infections, with both being approved by the FDA several decades ago. As they are antifungal medications acting on different mechanisms, they may be selected under varying circumstances. A comparative study conducted in 1979 found that both drugs demonstrated similar efficacy in managing symptoms of cutaneous candidiasis as well as demonstrating promising safety profiles.
A 2001 review indicates that nystatin is well-tolerated and effective at alleviating symptoms of oral thrush right from the first week of treatment. Its side effect profile is relatively mild compared to other antifungals and it has been used extensively even in pediatric and geriatric populations due to these favorable characteristics.
On the other hand, a review published in 2016 indicated that econazole seems to be more effective than placebo for treating athlete’s foot (tinea pedis), showing comparable efficacy to many common topical antifungal treatments. However, significant research involves econazole combined with corticosteroids or prescribed alongside an oral antifungal making its standalone data less robust than for nystatin. Nonetheless, due to its broad spectrum activity against dermatophytes (fungi causing skin infections), yeasts, molds, and other fungi; econazole might be optimal for patients who did not respond well to other topical therapies or have a need to avoid systemic side effects associated with oral medications.
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At what dose is Nystatin typically prescribed?
Topical applications of Nystatin are typically applied to the affected area twice daily, with a sufficient amount to cover the entire infected region. For severe or persistent infections, treatment may need to continue for several weeks. Conversely, Econazole is often prescribed as a 1% cream and should be applied once daily before bedtime in the case of vaginal yeast infections. For skin fungal infections, it should be applied thinly and evenly to the affected areas once or twice daily as directed by your healthcare provider. The duration of treatment depends on the severity and location of infection but typically ranges from 2 weeks up to 6 weeks.
At what dose is Econazole typically prescribed?
Econazole therapy begins with a recommended dosage of 1% cream or solution applied topically to the affected area once daily. The treatment may be continued for up to four weeks, depending on the severity and response to the medication. For some infections, it might be necessary to apply Econazole twice daily. The maximum dose is typically application of 1% cream or solution twice per day, which should not be exceeded unless there's no observable improvement after several weeks of regular usage under medical supervision. Always ensure you follow your healthcare provider's instructions regarding use and do not misuse this antifungal agent.
What are the most common side effects for Nystatin?
Here are common side effects that you might experience with nystatin and econazole:
- Irritation, itching, or burning at the site of application
- Rashes and skin inflammation
- Swelling
- Tenderness in the area where the medication was applied
- Pain or discomfort in the stomach
- Diarrhea
- Nausea or vomiting
Remember to consult your healthcare provider if you experience any of these symptoms. It's important to note that this list is not exhaustive; other more serious side effects can occur. Always follow your doctor's advice when taking any medication.
Are there any potential serious side effects for Nystatin?
In general, Nystatin and Econazole are both considered safe for use but as with any medication, they can cause side effects in some individuals. Some of these might include:
- Skin irritation such as rashes or hives
- Difficulty breathing, which could be a sign of a severe allergic reaction
- Swelling in your face or throat that could make it difficult to breathe
- A fever accompanied by a sore throat; this can indicate an infection
- Reddening of the eyes along with pain or swelling; this may signify an adverse reaction to either drug
- Fast heartbeat sensations, chest discomfort/pain, shortness of breath and dizziness - these symptoms could point towards heart complications.
Rarely do antifungal medications like Nystatin and Econazole affect the body's sodium levels causing confusion, weakened strength, vomiting and loss of coordination. In extreme cases where there is an adverse effect on the nervous system you may experience muscle rigidity, high fever, confusion and tremors.
It is important to note that serotonin syndrome is not commonly associated with antifungal medications like Nystatin or Econazole.
If you experience any of the above symptoms while using either Nystatin or Econazole it’s crucial you seek medical attention immediately.
What are the most common side effects for Econazole?
Econazole, an antifungal medication used to treat a variety of skin infections, can cause the following side effects:
- Mild itching or burning
- Redness or swelling where the medicine was applied
- Rash
- Peeling of affected skin
- Tenderness or pain at application site
- Unusual blistering
As with any medication, some individuals may experience more severe reactions. It is always recommended to discuss potential side effects and your personal health history with a healthcare provider before starting a new therapy.
Are there any potential serious side effects for Econazole?
While Econazole is typically safe and effective for treating fungal infections, there are potential side effects that may indicate a more serious reaction. These can include:
- Signs of an allergic reaction such as hives, itching, difficulty breathing or swelling in your face or throat
- Severe skin reactions such as burning sensation at the application site, redness, blistering or peeling skin
- Unusual changes in mood or behavior including feeling confused
- Vision disturbances like blurred vision or eye pain
- Rapid heartbeat which could be irregular, too slow (bradycardia) or fast (tachycardia)
If any of these symptoms occur after using Econazole cream or ointment, it's important to stop use and seek medical attention immediately.
Contraindications for Nystatin and Econazole?
Both Nystatin and Econazole, as antifungal medications, may cause side effects in some people. If you notice your condition worsening or experience any severe skin reactions such as hives, rash, itching or swelling after using these drugs, please seek immediate medical attention.
Neither Nystatin nor Econazole should be used if you are allergic to any of their ingredients. Allergic reactions can be serious and may result in shortness of breath or difficulty breathing. It is always crucial to inform your physician about all the medications you are taking; this includes over-the-counter medicines, vitamins and herbal supplements.
Avoid contact with eyes while applying either medication topically; they are not meant for ophthalmic use. The prolonged usage of topical steroids like econazole can sometimes lead to skin thinning or adrenal suppression so it's important to follow your doctor’s advice regarding duration of treatment.
Additionally, pregnant women or those who plan on becoming pregnant should discuss potential risks with their healthcare provider before starting treatment with either nystatin or econazole.
How much do Nystatin and Econazole cost?
For the brand name versions of these antifungal drugs:
- The price for a 30g tube of Nystop (nystatin) powder, which is equivalent to approximately 100 million units, averages around $65. Depending on your dosage and frequency, this could work out to be between $2-$4/day.
- The price for a 15g tube of Spectazole (econazole nitrate) cream (1%) is about $75, which works out to roughly $5/day depending on your application amount.
Thus, if you are in need of higher dosages or more frequent applications, then Nystop might be less expensive on a per-day treatment basis. However cost should not be the primary consideration in determining which of these medications is right for you.
As far as generic versions go:
- Generic nystatin comes in various forms with prices ranging from about $10 for 30g topical powder up to around $50 for oral suspension. This equates to anywhere from under a dollar up to several dollars per day.
- Econazole nitrate also varies significantly depending on form and quantity; however it's generally cheaper than its branded counterpart with costs typically falling between one and two dollars per day.
Popularity of Nystatin and Econazole
Nystatin, both in its generic form and under brand names like Mycostatin, was estimated to have been prescribed to about 3.2 million people in the US in 2020. Nystatin accounted for nearly 15% of antifungal prescriptions nationwide. This polyene antifungal medication is commonly used to treat Candida infections of the skin, mouth, esophagus, and vagina. Over the past decade or so, nystatin’s prevalence has remained steady.
Econazole, including branded versions such as Spectazole, was prescribed to approximately 1.8 million individuals in the USA during that same year. Econazole makes up just above 10% of all topical antifungal prescriptions within this time frame and is generally used for skin fungal infections such as ringworm and athlete's foot. The usage rate of econazole has also been relatively constant over recent years.
Conclusion
Both Nystatin and Econazole are tried-and-true antifungal medications, with substantial clinical evidence supporting their effectiveness in treating fungal infections. Sometimes, these two drugs may be used together for a synergistic effect on combating stubborn or severe fungal infections; however, this decision must be made carefully by a healthcare professional as they can also interact negatively.
Nystatin primarily works by binding to sterols in the cell membrane of susceptible fungi causing leakage of cellular contents and eventual death of the fungi. It is typically used topically for cutaneous or mucosal candida infections. On the other hand, Econazole acts similarly but it has broader antifungal coverage including dermatophytes and some dimorphic fungi making it better suited to treat tinea (ringworm) type infections.
Both drugs come in generic forms which can help patients save money especially when paying out-of-pocket. The onset of action might not be immediate upon starting treatment with either medication as clearing a fungal infection often requires sustained use over days to weeks depending on severity and location.
The side-effect profiles between Nystatin and Econazole are quite similar; both being generally well-tolerated but minor local irritation at the site of application can occur such as burning or itching sensation. For individuals using these treatments, close observation for allergic reactions such as rash or worsening symptoms is advisable. Immediate medical help should be sought if any adverse symptoms persist after usage.
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Refrences
- Firooz, A., Nafisi, S., & Maibach, H. I. (2015, November). Novel drug delivery strategies for improving econazole antifungal action. International Journal of Pharmaceutics. Elsevier BV.http://doi.org/10.1016/j.ijpharm.2015.09.015
- Heel, R. C., Brogden, R. N., Speight, T. M., & Avery, G. S. (1978, September). Econazole. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00003495-197816030-00001
- Chen, Q., Chu, H., Tao, Y., Peng, L., Zhou, L., Liu, L., & Wu, X. (2020, November 3). A Comparison of Triamcinolone Acetonide Econazole Cream and Nystatin Suspension in Treatment of Otomycosis. The Laryngoscope. Wiley.http://doi.org/10.1002/lary.29190