From the Guidelines
Best Treatment for Candidiasis
The best treatment for candidiasis is typically an antifungal medication, with fluconazole being a commonly recommended option 1. A single dose of 150mg fluconazole is often prescribed, but in some cases, a longer course of treatment with medications like clotrimazole, miconazole, or terconazole may be necessary, usually for 3-7 days.
Uncomplicated vs. Complicated Candidiasis
- Uncomplicated candidiasis can be effectively treated with either single-dose fluconazole or short-course fluconazole for 3 days, both of which achieve >90% response 1.
- Complicated candidiasis requires therapy to 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
For recurrent vulvovaginal candidiasis, treatment should begin 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. The most convenient and well-tolerated regimen is 150 mg fluconazole once weekly, which achieves control of symptoms in >90% of patients 1.
Important Considerations
It's essential to consult a healthcare provider for a proper diagnosis and to determine the most suitable treatment, as they can recommend the best course of treatment based on individual needs and medical history 1. Additionally, treatment of Candida glabrata vulvovaginal candidiasis is problematic, and azole therapy is frequently unsuccessful 1. In such cases, alternative treatments like boric acid or nystatin may be considered 1.
From the FDA Drug Label
Esophageal candidiasis: The recommended dosage of fluconazole tablets for esophageal candidiasis is 200 mg on the first day, followed by 100 mg once daily. Oropharyngeal candidiasis: The recommended dosage of fluconazole tablets for oropharyngeal candidiasis in children is 6 mg/kg on the first day, followed by 3 mg/kg once daily. Vaginal candidiasis: Two adequate and well-controlled studies were conducted in the U. S. using the 150 mg tablet. The best treatment for candidiasis is fluconazole, with the dosage varying depending on the type and severity of the infection, as well as the patient's age and renal function.
- Esophageal candidiasis: 200 mg on the first day, followed by 100 mg once daily
- Oropharyngeal candidiasis: 6 mg/kg on the first day, followed by 3 mg/kg once daily
- Vaginal candidiasis: 150 mg single dose 2 2
From the Research
Treatment Options for Candidiasis
- Topical antifungals, such as polyene antimycotics (e.g., amphotericin B and nystatin) and azoles (e.g., miconazole), are suitable for yeast infections of the skin and mucous membranes 3.
- For severe yeast infections of the skin and mucous membranes, oral triazole antimycotics, such as fluconazole and itraconazole, are used 3.
- Fluconazole is well established as a first-line management option for the treatment and prophylaxis of localized and systemic Candida albicans infections 4.
- Itraconazole can be effective in AIDS patients with C. albicans infections that are non-responsive to fluconazole 4.
Comparison of Antifungal Agents
- A study comparing terbinafine, itraconazole, and fluconazole in the treatment of Vulvovaginal candidiasis found that fluconazole had the highest clinical cure rate (66.6%) and mycologic cure rate (66.6%) 5.
- Another study found that fluconazole was effective in 53% of patients with systemic fungal infections, with a clinical and mycological response achieved in 62% and 65% of patients with proven or probable Candida albicans infections, respectively 6.
Resistance to Antifungal Agents
- Resistance to azole-derivative antifungals, including fluconazole, itraconazole, and ketoconazole, has been observed in Candida spp. 7.
- The frequency of resistance to these agents differs, with fluconazole being implicated in emergent resistance more frequently than ketoconazole, and ketoconazole more often than itraconazole 7.