I chose to treat this patient only
with nystatin. The sole effect of this drug is to
suppress yeast growth; it is the most widely used
drug for this purpose. It is used in tablet form for
intestinal, suppository for vaginal, and suspension
for oral yeast infections; in addition, it may be
used topically for skin and nail involvement. It is
absorbed from the intestine in such small amount
that it is of no value for treating Candida
infections of the internal organs. In fact, if it were
absorbed in the small intestine, it would not reach
the large intestine and would therefore be
ineffective in treating yeast growth in the bowel.
Since pharmacologically this drug has no effect
other than to suppress yeast growth on mucosal
and skin surfaces, any symptoms that are cleared
by its administration may be presumed to have
been caused by yeast. This would apply not only
to symptoms and signs related to the skin and
mucous membrane colonization, but more
importantly to those arising in an organ itself not
infected by this fungus.
In this young woman I hoped to determine
whether clearing the mucous membrane
involvement in the colon and vagina would be
possible with nystatin alone, and if it were,
whether the central nervous system symptoms
of anxiety and depression would clear. She
responded quickly to this therapy; in 10 days
she was totally free of all symptoms and
having normal bowel movements. I
discontinued treatment and within two days
all symptoms returned, only to cease quickly
on resumption of treatment. After three weeks
without symptoms, I halved the dose from 16
to eight tablets per day. She again relapsed
and again quickly cleared on return to the
original dose. After another six weeks of
symptom-free therapy with four tablets four
times a day and one vaginal suppository twice
daily, she remained well when treatment was
stopped. At the time of my last contact with
her one year later, she was well. Her followup
letter to me at that time concluded with the
following statement, "I personally feel that I
have had a complete recovery since I no
longer have any problem with waste
elimination and my nerves and hay fever have
caused me no trouble since I finished taking
the pill which you prescribed."