From the Guidelines
The recommended treatment for vaginal yeast infection is typically an antifungal medication, with options including over-the-counter topical azole antifungals like clotrimazole, miconazole, or tioconazole, or prescription oral fluconazole 150mg as a single dose, as supported by the 2021 Centers for Disease Control and Prevention guidelines 1.
Treatment Options
- 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
Important Considerations
- For severe or recurrent infections, longer courses of treatment may be necessary, such as fluconazole 150mg every 72 hours for 3 doses, or 7-14 days of topical therapy 1.
- During treatment, it is essential to avoid douching, scented hygiene products, and tight-fitting clothing that can worsen symptoms.
- Sexual partners generally do not need treatment unless they have symptoms.
- These medications work by disrupting the fungal cell membrane, preventing the yeast (usually Candida albicans) from growing and reproducing.
- Symptoms typically improve within 2-3 days, but it is crucial to complete the full course of medication even if symptoms resolve early to prevent recurrence.
From the FDA Drug Label
What Is Fluconazole? Fluconazole is a tablet you swallow to treat vaginal yeast infections caused by a yeast called Candida. Fluconazole helps stop too much yeast from growing in the vagina so the yeast infection goes away.
The recommended treatment for vaginal yeast infection is fluconazole, a tablet taken by mouth, as it helps stop the growth of yeast in the vagina, allowing the infection to clear up 2.
- Key points:
- Fluconazole is used to treat vaginal yeast infections caused by Candida.
- It is a tablet taken by mouth.
- It helps stop the growth of yeast in the vagina.
From the Research
Treatment Options for Vaginal Yeast Infection
The recommended treatment for vaginal yeast infection includes:
- Topical antifungal agents such as clotrimazole, miconazole, terconazole, and intravaginal boric acid 3
- Oral fluconazole as first-line maintenance therapy, with intermittent topical treatments considered if oral regimen is not feasible 3
- Combined systemic (fluconazole) and topical (metronidazole + clotrimazole) therapy for recurrent candidiasis 4
- Local treatment with antifungal agents such as Nizoral, Clotrimazole, Canesten, Gyno-Daktarine, Gyno-Pevaryl, Miconazole for acute vaginal yeast infection 5
Specific Treatment Regimens
- Clotrimazole 500 mg vaginal tablets as a single dose or multiple doses for uncomplicated vulvovaginal candidosis 6
- Fluconazole 200 mg on day 1,4,11,26, then 1 dose/month for 3 months for recurrent vulvovaginal candidosis 4
- Metronidazole/clotrimazole ovules 1/day for 6 days the first week, then 1 ovule/day for 3 days the week before the menstrual cycle for 3 months 4
Considerations for Treatment
- Identification of species will influence treatment decisions, with non-albicans species requiring different treatment approaches 3
- Treatment may be modified based on prior response to a specific agent, especially in non-albicans species 3
- Fluconazole, ibrexafungerp, and intravaginal boric acid should be avoided during pregnancy 3
- Resistance to C. albicans does not play a significant role in the use of polyenes or azoles, but Candida krusei is resistant to triazoles 7