What are the treatment options for candidiasis (fungal infection)?

From the Guidelines

Yeast infections can be effectively treated with antifungal medications, with fluconazole being a recommended option for most cases, as stated in the 2016 update by the Infectious Diseases Society of America 1.

Treatment Options

• For vaginal yeast infections, over-the-counter options include miconazole (Monistat) or clotrimazole (Gyne-Lotrimin) creams or suppositories, typically used for 1-7 days depending on the formulation strength.
• Oral fluconazole (Diflucan) 150mg as a single dose is also effective and available by prescription, with a response rate of >90% for uncomplicated infections 1.
• For skin yeast infections, apply clotrimazole, miconazole, or terbinafine creams twice daily for 1-2 weeks.
• Oral thrush responds well to nystatin oral suspension (swish and swallow 4-5 times daily) or clotrimazole troches dissolved in the mouth.

Considerations

• The diagnosis of vulvovaginal candidiasis should be confirmed by a wet-mount preparation with use of saline and 10% potassium hydroxide to demonstrate the presence of yeast or hyphae and a normal pH (4.0–4.5) before proceeding with empiric antifungal therapy 1.
• Complicated vulvovaginal candidiasis requires that therapy be administered intravaginally with topical agents for 5–7 days or orally with fluconazole 150 mg every 72 hours for 3 doses 1.
• Recurrent vulvovaginal candidiasis can be treated with induction therapy with a topical agent or oral fluconazole for 10–14 days, followed by a maintenance azole regimen for at least 6 months 1.

Important Notes

• During treatment, maintain good hygiene, wear loose cotton underwear for vaginal infections, and avoid irritants like scented products.
• Complete the full treatment course even if symptoms improve quickly.
• Yeast infections occur when Candida fungi overgrow, often due to antibiotic use, hormonal changes, diabetes, or weakened immunity.
• If symptoms persist after treatment, recur frequently, or you're pregnant, consult a healthcare provider for proper diagnosis and treatment.

From the FDA Drug Label

Dosage and Administration in Adults: Single Dose Vaginal candidiasis: The recommended dosage of fluconazole tablets for vaginal candidiasis is 150 mg as a single oral dose. The recommended treatment for yeast infection is fluconazole 150 mg as a single oral dose 2.

• Key points:
  • The dosage is for vaginal candidiasis.
  • The treatment is a single oral dose.

From the Research

Treatment Options for Yeast Infection

• The main classes of antifungal drugs used to treat yeast infections are polyenes, azoles, allylamines, and echinocandins 3.
• Topical azole formulations, such as fluconazole and itraconazole, are commonly used to treat superficial yeast infections 3, 4.
• Systemic antifungal agents, such as fluconazole, itraconazole, and voriconazole, can be used to treat more severe or invasive yeast infections 3, 5, 4.
• Echinocandins, such as caspofungin, are effective in treating Candida and Aspergillus infections, but can only be used intravenously 3, 5.

Specific Treatment Recommendations

• Fluconazole is a well-established first-line treatment option for Candida albicans infections, including vulvovaginal candidiasis 4, 6.
• Itraconazole can be used as a second-line therapy for patients who do not respond to fluconazole 4.
• Topical antifungal agents, such as nystatin and miconazole, are effective in treating oral candidiasis, but may require a long treatment duration 5, 7.
• Fluconazole and amphotericin B are recommended as topical antifungal agents for adults with oral candidiasis, while miconazole is recommended for infants 7.

Considerations for Treatment

• The choice of antifungal agent should be based on the severity and location of the infection, as well as the patient's immune status and medical history 3, 5.
• Combination antifungal therapy may be necessary in some cases, but should be used with caution due to the risk of adverse effects and drug interactions 3.
• The emergence of fluconazole-resistant Candida albicans strains is a concern, and alternative treatment options should be considered in cases of treatment failure 6.