Treatment of Yeast Infections Caused by Antibiotic Use
For uncomplicated yeast infections caused by antibiotic use, a single 150 mg oral dose of fluconazole is the recommended first-line treatment. 1
Diagnosis
Before initiating treatment, confirm the diagnosis by:
- Identifying symptoms: pruritus, irritation, vaginal soreness, and white discharge
- Performing a wet mount preparation with saline and 10% potassium hydroxide to visualize yeast or hyphae
- Checking vaginal pH (should be <4.5 for yeast infections)
Treatment Options
First-Line Treatment:
- Oral therapy:
- Fluconazole 150 mg as a single oral dose 1
Alternative Topical Treatments:
- Intravaginal azole preparations: 1
- Butoconazole 2% cream 5g intravaginally for 3 days
- Clotrimazole 1% cream 5g intravaginally for 7-14 days
- Clotrimazole 100mg vaginal tablet for 7 days
- Clotrimazole 100mg vaginal tablet, two tablets for 3 days
- Clotrimazole 500mg vaginal tablet, single application
- Miconazole 2% cream 5g intravaginally for 7 days
- Miconazole 100mg vaginal suppository, one suppository for 7 days
- Miconazole 200mg vaginal suppository, one suppository for 3 days
- Tioconazole 6.5% ointment 5g intravaginally in a single application
- Terconazole 0.4% cream 5g intravaginally for 7 days
- Terconazole 0.8% cream 5g intravaginally for 3 days
- Terconazole 80mg vaginal suppository, one suppository for 3 days
Treatment Considerations
For Uncomplicated Infections:
- Single-dose fluconazole 150mg provides clinical efficacy rates of 92-99% at short-term evaluation 2
- Oral fluconazole is well-tolerated with minimal side effects, primarily mild gastrointestinal complaints 3
For Complicated Infections:
- For severe symptoms: Two sequential doses of fluconazole 150mg given 3 days apart 4
- For recurrent infections: Initial induction therapy with fluconazole 150mg daily for 10-14 days, followed by maintenance therapy with fluconazole 150mg weekly for 6 months 1, 5
For Non-albicans Candida Species:
- For suspected C. glabrata (which may be fluconazole-resistant):
Follow-Up
- Return for follow-up only if symptoms persist or recur within 2 months 1
- For recurrent infections, consider screening for underlying conditions such as diabetes or immunosuppression 5
Important Considerations
- Oil-based creams and suppositories may weaken latex condoms and diaphragms 1
- Self-medication with over-the-counter preparations should only be advised for women previously diagnosed with yeast infections who have recurrence of the same symptoms 1
- Treatment of sexual partners is not routinely recommended for vaginal candidiasis but may be considered for women with recurrent infections 1
- Fluconazole may interact with other medications through inhibition of CYP2C9, CYP2C19, and CYP3A4 enzymes 6
Prevention Strategies
- Maintain good hygiene
- Wear loose-fitting cotton underwear
- Avoid prolonged moisture in the genital area
- Consider prophylactic therapy in cases of recurrent infections