What is the treatment for vulvovaginal candidiasis (VVC)?

From the Guidelines

To treat vaginal fungal infections, topical antifungal agents or a single 150-mg oral dose of fluconazole is recommended. The treatment approach depends on the severity of the infection. For uncomplicated Candida vulvovaginitis,

• topical antifungal agents, with no one agent superior to another, are recommended 1
• alternatively, a single 150-mg oral dose of fluconazole can be used 1. For severe acute Candida vulvovaginitis,
• fluconazole 150 mg, given every 72 hours for a total of 2 or 3 doses, is recommended 1. It is essential to maintain good hygiene during treatment by keeping the vaginal area clean and dry, wearing cotton underwear, avoiding tight clothing, and abstaining from sexual intercourse or using condoms. Avoiding douching, scented products, and sitting in wet clothing can also help prevent the recurrence of infections. If symptoms persist after treatment, worsen, or recur frequently, consulting a healthcare provider is necessary to determine the best course of action.

From the FDA Drug Label

Vaginal candidiasis: Two adequate and well-controlled studies were conducted in the U. S. using the 150 mg tablet. In both, the results of the fluconazole regimen were comparable to the control regimen (clotrimazole or miconazole intravaginally for 7 days) both clinically and statistically at the one month post-treatment evaluation The therapeutic cure rate, defined as a complete resolution of signs and symptoms of vaginal candidiasis (clinical cure), along with a negative KOH examination and negative culture for Candida (microbiologic eradication), was 55% in both the fluconazole group and the vaginal products group Fluconazole PO 150 mg tablet Vaginal Product qhs x 7 days Enrolled 448 422 Evaluable at Late Follow-up 347 (77%) 327 (77%) Clinical cure 239/347 (69%) 235/327 (72%) Mycologic eradication 213/347 (61%) 196/327 (60%) Therapeutic cure 190/347 (55%) 179/327 (55%)

To treat fungal infections in the vagina, fluconazole can be used as a single 150 mg oral dose, with a therapeutic cure rate of 55% 2.

• Clinical cure was achieved in 69% of patients
• Mycologic eradication was achieved in 61% of patients Alternatively, vaginal products such as clotrimazole can be used, with similar efficacy to fluconazole 3. Key points to consider when treating fungal infections in the vagina include:
• The choice of treatment should be based on the severity of symptoms and the patient's medical history
• Patients with recurrent vaginitis may require different treatment approaches
• Gastrointestinal events are more common with fluconazole than with vaginal products 2

From the Research

Treatment Options for Fungal Infections in the Vagina

• The treatment of vaginal candidiasis can be based on two principles: elimination of predisposing factors and antifungal treatment 4.
• Local treatment is the first line of choice in cases of acute vaginal yeast infection, with a success rate of 84-90% 4.
• Different groups of broad-spectrum oral antimycotics, including fluconazole, can be used to treat vaginal candidiasis 4, 5.
• A combined scheme using both systemic antimicrobial drug therapy with oral fluconazole and topical drug therapy using metronidazole and clotrimazole can be effective in treating recurrent vulvovaginal candidiasis (RVVC) 6.
• New antifungals, such as ibrexafungerp and oteseconazole, are now available for the treatment of vulvovaginal candidiasis, although their role is still unclear 7.

Comparison of Treatment Options

• Oral fluconazole 150 mg single dose has been shown to be a valid and promising therapy to cure acute signs and symptoms of vulvovaginal candidiasis, with a higher success rate than intra-vaginal clotrimazole treatment 5.
• The choice between oral and topical treatment depends on the therapeutic results, side effects, pregnancy status, and patient preference 8.
• Oral therapy should not be given to pregnant patients or to patients not using reliable contraceptive measures 8.

Recurrent Infections

• The treatment of chronic, recurrent, and resistant forms of vaginal candidosis requires prolonged local and/or systemic therapy for a period of at least 6 months 4.
• A combined treatment scheme using fluconazole, metronidazole, and clotrimazole, along with oral probiotic therapy, may be effective in preventing recurrence of RVVC 6.