Treatment of Yeast Infections
For uncomplicated vulvovaginal candidiasis (VVC), a single 150-mg oral dose of fluconazole or topical antifungal agents are equally effective first-line treatments. 1
First-Line Treatment Options
Oral Therapy
- Fluconazole 150 mg single oral dose
Topical Therapy Options
- Clotrimazole vaginal tablets/cream
- Miconazole vaginal suppositories/cream
- Nystatin vaginal tablets
- Duration depends on specific formulation 1
- No one topical agent is superior to another 1
Treatment Based on Severity
Uncomplicated VVC
- Single 150 mg oral dose of fluconazole OR
- Topical antifungal for 1-7 days (depending on formulation) 1
Severe VVC
- Two sequential doses of fluconazole 150 mg given 3 days apart
- Achieves significantly higher clinical cure rates compared to single dose 3
Recurrent VVC
- Initial treatment with fluconazole 150 mg every 72 hours for 2-3 doses 1
- Followed by maintenance therapy with fluconazole 150 mg weekly for 6 months to prevent recurrence 1
Alternative Treatment Options
For patients who don't respond to first-line therapy or have non-albicans Candida species:
- Topical intravaginal boric acid 600 mg daily for 14 days 1
- Nystatin intravaginal suppositories 100,000 units daily for 14 days 1
- Topical 17% flucytosine cream alone or with 3% AmB cream daily for 14 days 1
Important Considerations
Patient Factors Affecting Treatment Success
- Women with a history of recurrent vaginitis are significantly less likely to respond clinically and mycologically to treatment 4
- Infections with non-albicans Candida species predict significantly reduced clinical and mycologic response regardless of therapy duration 3
Safety Considerations
- Fluconazole is generally well-tolerated with mostly mild gastrointestinal side effects 5, 2
- Caution: Fluconazole should not be used in patients taking:
- Quinidine
- Erythromycin
- Pimozide 5
- Fluconazole should be used with caution in patients with:
- Heart problems (risk of QT prolongation)
- Renal dysfunction
- Hypokalemia 5
- Not recommended during pregnancy or lactation 6
Clinical Pearls
- Diagnosis should be confirmed before treatment through wet mount preparation, vaginal pH measurement, and vaginal cultures when possible 1
- Oral administration is generally preferred by patients over local therapy 6
- Relapse rates of approximately 20-25% may occur even after successful initial treatment 7
By following these evidence-based recommendations, most patients with vulvovaginal candidiasis can expect resolution of symptoms and mycological cure.