From the Guidelines
For vaginal yeast infections, the most effective treatment is a single 150mg dose of oral fluconazole, as recommended by the 2021 Centers for Disease Control and Prevention guidelines 1.
Treatment Options
The treatment options for vulvovaginal candidiasis (VVC) include over-the-counter intravaginal agents, prescription intravaginal agents, and oral agents.
- Over-the-counter intravaginal agents:
- Clotrimazole 1% cream: 5 g intravaginally daily for 7–14 days
- Clotrimazole 2% cream: 5 g intravaginally daily for 3 days
- Miconazole 2% cream: 5 g intravaginally daily for 7 days
- Miconazole 4% cream: 5 g intravaginally daily for 3 days
- Miconazole 100 mg vaginal suppository: One suppository daily for 7 days
- Miconazole 200 mg vaginal suppository: One suppository for 3 days
- Miconazole 1200 mg vaginal suppository: One suppository for 1 day
- Tioconazole 6.5% ointment: 5 g intravaginally in a single application
- Prescription intravaginal agents:
- Butoconazole 2% cream (single dose bioadhesive product): 5 g intravaginally in a single application
- Terconazole 0.4% cream: 5 g intravaginally daily for 7 days
- Terconazole 0.8% cream: 5 g intravaginally daily for 3 days
- Terconazole 80 mg vaginal suppository: One suppository daily for 3 days
- Oral agent:
- Fluconazole 150 mg: Single dose
Diagnosis and Treatment
Diagnosis of VVC can be challenging due to the limitations of current diagnostic methods, including microscopy and clinical diagnosis, which have poor sensitivity, and yeast cultures, which can lead to a delay in diagnosis and treatment 1. However, a single dose of fluconazole has been shown to be effective in treating VVC, and its use is recommended by the CDC guidelines 1.
Important Considerations
During treatment, it is essential to avoid douching, scented products in the genital area, and tight-fitting clothing. If symptoms persist after treatment, the infection is recurrent, or you're pregnant, consult a healthcare provider for appropriate care.
From the FDA Drug Label
Fluconazole is generally well tolerated. In Patients Receiving a Single Dose for Vaginal Candidiasis: The overall incidence of side effects possibly related to fluconazole was 26%. The most common treatment-related adverse events reported in the patients who received 150 mg single dose fluconazole for vaginitis were headache (13%), nausea (7%), and abdominal pain (6%).
ADVERSE REACTIONS Adverse Reactions from Clinical Trials Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice During controlled clinical studies conducted in the United States, 521 patients with vulvovaginal candidiasis were treated with terconazole 0.4% vaginal cream. Based on comparative analyses with placebo, the adverse experiences considered most likely related to terconazole 0.4% vaginal cream were headache (26% vs. 17% with placebo) and body pain (2.1% vs. 0% with placebo).
The best vaginal yeast treatment between fluconazole and terconazole cannot be determined from the provided information, as efficacy is not directly compared in the drug labels.
- Fluconazole is administered orally, with common side effects including headache, nausea, and abdominal pain 2.
- Terconazole is administered vaginally, with common side effects including headache and body pain 3. No conclusion can be drawn regarding the best treatment option.
From the Research
Treatment Options
- Clotrimazole, miconazole, terconazole, and intravaginal boric acid are suggested recommendations for recurrent vulvovaginitis caused by both Candida albicans and nonalbicans species 4
- Imidazole agents (clotrimazole, miconazole, butoconazole, and terconazole) are preferred due to their greater efficacy, shorter treatment regimens, and ease of administration 5
- Fluconazole is a triazole that has established an exceptional therapeutic record for candida infections, including vulvovaginal candidiasis 6
Treatment Regimens
- An initial full course of treatment followed by topical maintenance beginning at one to three times weekly, based on chosen agent, is recommended for women with RVVC 4
- A combined scheme using both systemic antimicrobial drug therapy with oral fluconazole and topical drug therapy using the association metronidazole and clotrimazole (vaginal ovules) with adjuvant oral probiotic therapy has been proposed 7
- Shorter courses of therapy, including single-dose therapy, have been developed for most antifungal agents used for the treatment of vaginal candidiasis 8