From the Guidelines
Recurrent yeast infections should be treated with a 10-14 day induction therapy with a topical agent or oral fluconazole, followed by fluconazole 150 mg weekly for 6 months, as recommended by the Infectious Diseases Society of America 1. This approach is based on high-quality evidence and is considered a strong recommendation. The treatment aims to reduce the frequency and severity of recurrent vulvovaginal candidiasis.
- Key points to consider:
- Induction therapy with a topical agent or oral fluconazole for 10-14 days
- Maintenance therapy with fluconazole 150 mg weekly for 6 months
- Importance of completing the full treatment course to prevent recurrence
- Potential need for lifestyle changes, such as wearing loose cotton underwear and avoiding scented hygiene products, to reduce the risk of recurrence. It is essential to note that recurrent yeast infections can be a sign of an underlying condition, such as diabetes or immunosuppression, and if infections persist despite treatment, a healthcare provider should be consulted to rule out these conditions 1.
From the FDA Drug Label
The remaining one-fourth of enrolled patients had recurrent vaginitis (≥4 episodes/12 months) and achieved 57% clinical cure, 47% mycologic eradication, and 40% therapeutic cure The FDA-approved treatment for recurrent yeast infections with fluconazole has a clinical cure rate of 57%, mycologic eradication rate of 47%, and therapeutic cure rate of 40% 2.
- Clinical cure is defined as a complete resolution of signs and symptoms of vaginal candidiasis.
- Mycologic eradication is defined as a negative KOH examination and negative culture for Candida.
- Therapeutic cure is defined as both clinical cure and mycologic eradication. The numbers are too small to make meaningful clinical or statistical comparisons with vaginal products in the treatment of patients with recurrent vaginitis.
From the Research
Treatment Options for Recurrent Yeast Infections
- The current Centers for Disease Control and Prevention (CDC) guidelines recommend oral fluconazole as first-line maintenance for recurrent vulvovaginal candidiasis (RVVC), but topical treatments can be considered if oral regimens are not feasible 3.
- Topical maintenance dosing for RVVC may include clotrimazole, miconazole, terconazole, and intravaginal boric acid, which are effective against both Candida albicans and non-albicans species 3.
- Boric acid is a safe and effective alternative treatment for women with recurrent and chronic symptoms of vaginitis, especially when conventional treatment fails due to non-albicans Candida species or azole-resistant strains 4.
Effectiveness of Boric Acid and Fluconazole
- Boric acid has been found to inhibit growth of yeast isolates in different morphologies and is effective against various Candida species, including those with intrinsic resistance to fluconazole 5.
- Fluconazole is the primary antifungal drug used to treat RVVC, but its effectiveness can be limited by the development of resistance, particularly in non-albicans species 6, 7.
- Boric acid is broadly effective at inhibiting growth across many isolates and morphologies, making it a useful treatment option for RVVC 5.
Considerations for Treatment
- Identification of the Candida species and prior response to treatment can influence treatment decisions 3.
- Fluconazole, ibrexafungerp, and intravaginal boric acid should be avoided during pregnancy 3.
- The development of antifungal resistance, particularly in non-albicans species, is a concern and may impact treatment options 7.