From the Guidelines
For the treatment of skin and soft tissue yeast infections, oral fluconazole is recommended as the first-line treatment, with a dosage of 200-400 mg (3-6 mg/kg) 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 Candida infections 1.
Key Considerations
- The treatment duration may need to be extended to 3-4 weeks for more extensive infections.
- Alternative medications, such as itraconazole 200 mg daily or voriconazole 200 mg twice daily, can be used for fluconazole-refractory disease or in patients who cannot tolerate fluconazole.
- Patients with liver disease or those taking medications that interact with azoles may require alternative treatments, such as terbinafine 250 mg daily.
- It is essential to complete the full course of treatment, even if symptoms improve quickly, to prevent recurrence.
Monitoring and Prevention
- Patients should be monitored for potential side effects, including liver enzyme elevations.
- Cultures can be beneficial in identifying the specific yeast species for targeted therapy in patients with recurrent infections.
- Maintaining good skin hygiene, keeping affected areas dry, and avoiding tight clothing can help prevent recurrence after successful treatment.
Evidence-Based Recommendations
The recommendations are based on the 2016 update of the clinical practice guideline for the management of candidiasis by the Infectious Diseases Society of America 1. This guideline provides strong evidence for the use of fluconazole as the first-line treatment for skin and soft tissue yeast infections. Other studies, such as the 2016 update on triazoles, also support the use of fluconazole and provide information on alternative treatments and potential side effects 1.
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.