What is the treatment for vaginal candidiasis?

From the Guidelines

The treatment for vaginal candidiasis typically involves antifungal medications, with a short course of topical azoles like clotrimazole or miconazole, or single-dose oral fluconazole (150 mg) being effective for uncomplicated cases. For uncomplicated cases, the recommended treatment options include:

• Over-the-counter intravaginal agents such as clotrimazole 1% cream applied intravaginally for 7-14 days, clotrimazole 2% cream for 3 days, miconazole 2% cream for 7 days, or miconazole 100 mg vaginal suppository for 7 days 1
• Prescription intravaginal agents such as butoconazole 2% cream, terconazole 0.4% cream, or terconazole 0.8% cream 1
• Oral agent fluconazole 150 mg single dose 1 For severe or recurrent infections, longer treatment courses may be needed, such as fluconazole 150 mg taken every 72 hours for three doses, or extended topical therapy for 7-14 days. During treatment, patients should avoid douching, scented hygiene products, and tight-fitting synthetic underwear. Sexual partners generally don't need treatment unless they have symptoms. Pregnant women should use topical azoles rather than oral medications. These treatments work by disrupting the fungal cell membrane, preventing the yeast from growing and reproducing. Most women experience symptom relief within 2-3 days of starting treatment, though complete resolution may take longer.

Some key points to consider when treating vaginal candidiasis include:

• The diagnosis should be confirmed by a wet mount preparation with use of saline and 10% potassium hydroxide to demonstrate the presence of yeast or hyphae, and vaginal cultures for Candida should be obtained if the wet mount findings are negative 1
• The treatment should not differ on the basis of HIV infection status, and identical response rates are anticipated for HIV-positive and HIV-negative women 1
• Recurrent vaginal candidiasis is defined as ≥4 episodes of symptomatic infection within 1 year, and is usually caused by azole-susceptible C. albicans 1
• Induction therapy with 10–14 days of a topical or oral azole should be followed by a suppressive regimen for at least 6 months, with the most convenient and well-tolerated regimen being once weekly oral fluconazole at a dose of 150 mg 1

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%)

The treatment for vaginal candidiasis is fluconazole 150 mg tablet administered orally, with a therapeutic cure rate of 55%. Alternatively, vaginal products such as clotrimazole or miconazole can be used, with a comparable therapeutic cure rate of 55% 2.

• Clinical cure was achieved in 69% of patients treated with fluconazole and 72% of patients treated with vaginal products.
• Mycologic eradication was achieved in 61% of patients treated with fluconazole and 60% of patients treated with vaginal products.

From the Research

Treatment Options for Vaginal Candidiasis

• The treatment for vaginal candidiasis includes various antifungal medications, such as clotrimazole, fluconazole, and miconazole 3, 4, 5.
• Clotrimazole is a commonly used medication for the treatment of vulvovaginal candidosis, with high cure rates and effectiveness in uncomplicated cases 3.
• Fluconazole is also an effective treatment option, with a single oral dose being more effective in the long term and relieving symptoms more rapidly compared to intravaginal clotrimazole 4.
• Imidazole agents, such as clotrimazole, miconazole, butoconazole, and terconazole, are preferred due to their greater efficacy, shorter treatment regimens, and ease of administration 5.

Local Treatment Considerations

• Local treatment of vulvovaginal candidosis presents several advantageous and unique features, including the availability of numerous antifungal drugs and products for topical administration 6.
• Azoles and short-term regimens are usually recommended for the local treatment of vulvovaginal candidosis, with nystatin and boric acid considered as second-line alternatives 6.
• The choice of treatment should take into consideration factors such as pregnancy, menopause, drug hypersensitivity, women's preferences, and the availability and cost of antifungal formulations 6.

Future Treatment Directions

• The future of noninvasive azole antifungal treatment options for the management of vulvovaginal candidiasis is promising, with a focus on personalized treatment considering the woman's pregnancy status, concomitant treatments, and the clinical presentation of the infection 7.
• Topical antifungal drugs, such as clotrimazole and miconazole, remain relevant in many clinical situations, and there is a need to expand therapeutic tools with new antifungal agents and formulations 7.