From the Guidelines
Oral fluconazole is the recommended first-line treatment for skin and soft tissue yeast infections, typically prescribed at 200-400 mg daily for 14-21 days. This recommendation is based on the most recent and highest quality study available, which provides strong evidence for the effectiveness of fluconazole in treating candidiasis 1. The treatment duration may vary depending on the severity of the infection and the patient's immune status.
Key Considerations
- Before starting oral antifungals, liver function should be assessed as these medications can cause hepatotoxicity.
- Drug interactions are common with azole antifungals, particularly with statins, anticoagulants, and certain psychiatric medications, so a medication review is essential.
- For patients who cannot tolerate oral therapy, intravenous fluconazole or an echinocandin may be considered as alternative options 1.
- For fluconazole-refractory disease, itraconazole solution or voriconazole may be used as alternative treatments 1.
Treatment Options
- Fluconazole: 200-400 mg daily for 14-21 days
- Itraconazole: 200 mg daily for 14-21 days
- Voriconazole: 200 mg twice daily for 14-21 days
- Echinocandins: micafungin, 150 mg daily; caspofungin, 70-mg loading dose, then 50 mg daily; or anidulafungin, 200 mg daily for 14-21 days
Patient Care
- Patients should maintain good skin hygiene and keep affected areas dry during treatment.
- The full medication course should be completed even if symptoms improve quickly to prevent recurrence.
- Regular follow-up appointments should be scheduled to monitor the patient's response to treatment and adjust the treatment plan as needed.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options
- Oral antifungal agents such as fluconazole, itraconazole, and terbinafine can be used to treat skin and soft tissue yeast infections 2.
- Fluconazole is effective in treating pityriasis versicolor, tinea corporis/cruris, and tinea pedis 2.
- Itraconazole can be used to treat pityriasis versicolor, tinea corporis/cruris, and tinea pedis, but its use is limited by erratic bioavailability and numerous drug interactions 3, 4.
- Terbinafine is effective in treating tinea corporis/cruris and tinea pedis, but appears to be ineffective in treating pityriasis versicolor 2.
Antifungal Agents
- The four main classes of antifungal drugs are polyenes, azoles, allylamines, and echinocandins 5.
- Azoles, such as fluconazole, itraconazole, voriconazole, and posaconazole, have a broad spectrum of activity against yeasts and moulds 5, 4.
- Echinocandins, such as caspofungin, are effective in treating Candida and Aspergillus infections 5.
Treatment Considerations
- The choice of antifungal agent depends on the type and severity of the infection, as well as the patient's medical history and potential drug interactions 5, 4.
- Combination antifungal therapy may be appropriate in selected patients with invasive fungal infections, but is empiric and driven by individual physician practice 5.
- Early assessment of patient's clinical conditions and response to treatment can facilitate patients' discharge and optimize the treatment of skin and soft tissue infections 6.