Treatment of candida vulvovaginitis

1. For severe symptoms and chronic infections, a 7-day course of treatment is used, instead of a 1 day or 3 day course. If there is vulvar involvement, a cream should be used instead of a suppository.

2. Most C. albicans isolates are susceptible to either clotrimazole or miconazole. An increasing number of nonalbicans Candida species are resistant to the OTC antifungal agents and require the use of prescription antifungal agents. Greater activity has been achieved using terconazole, butoconazole, tioconazole, ketoconazole, and fluconazole.

Antifungal Medications

Medication

How Supplied

Dosage

Prescription Agents Oral Agents

Fluconazole (Diflucan) Ketoconazole (Nizoral)

150-mg tablet 200 mg

1 tablet PO 1 time 1 tablet PO bid for 5 days

Prescription Topical Agents

Butoconazole (Femstat)

2% vaginal cream [28 g]

1 vaginally applicatorful qhs for 3 nights

Clotrimazole (Gyne-Lotri-min)

500-mg tablet

1 tablet vaginally qhs 1 time

Miconazole (Monistat 3)

200-mg vaginal suppositories

1 suppository vaginally qhs for 3 nights

Tioconazole (Vagistat)

6.5% cream [5 g]

1 applicatorful vaginally qhs 1 time

Terconazole (Terazol 3)

Vag suppository: 80 mg [3]

One applicatorful intravaginally qhs x 7 days

One applicatorful intravaginally qhs x 3 days

One suppository intravaginally qhs x 3 days

Over-the-Counter Agents

Clotrimazole (Gyne-Lotrimin)

1% vaginal cream [45 g] 100-mg vaginal tablets

1 applicatorful vaginally qhs for 714 nights

1 tablet vaginally qhs for 7-14 days

Miconazole (Monistat 7)

100-mg vaginal suppository

1 applicatorful vaginally qhs for 7 days

1 suppository vaginally qhs for 7 days

3. Ketoconazole, 200-mg oral tablets twice daily for 5 days, is effective in treating resistant and recurrent candidal infections. Effectiveness is believed to be a result of the elimination of the rectal reservoir of yeast.

4. Resistant infections also may respond to vaginal use of boric acid, 600 mg in size 0 gelatin capsules daily for 14 days.

5. Treatment of male partners is usually not necessary but may be considered if the partner has yeast balanitis or is uncircumcised.

6. During pregnancy, butoconazole (Femstat) should be used in the 2nd or 3rd trimester. Miconazole or clotrimazole may also be used.

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