Evaluation of a nystatin-containing mouth rinse for terminally ill patients in palliative care

Purpose: To evaluate the antifungal effect of a nystatin mouth rinse to control oral candidiasis of elderly patients in palliative care. Materials and( Methods: 52 cancer patients (mean age: 83 years) hospitalized in a long term care facility for chronically ill geriatric patients. Mouth rinsing with 15 ml nystatin solution (4,000 Ul/ml) was carried out for one minute, six times daily, over two weeks. Yeasts were collected and seeded on CHROMagar. Growth was read qualitatively and quantitatively after two days' incubation at 37degreesC. Results: Clinical signs of oral candidiasis were observed in 31% of cases. High yeast scores were observed in 58% of the residents. There was an association between signs of oral candidiasis and high yeast scores (p<0.001). Treatment for two weeks caused no clinical changes nor reduced yeast scores. Conclusions: No clinical or antifungal effect from the nystatin suspension suggests that the concentration of nystatin in the mouth rinse was too low. A more effective procedure should be employed for antifungal treatment of terminally ill patients. Appropriate antimicrobial solutions with lubricating activity should be developed and applied to prevent oral diseases.