Are there vaginal suppository formulations of Fluconazole (antifungal medication) available for the treatment of vaginal candidiasis?

Fluconazole Vaginal Suppositories for Candidiasis

No, fluconazole is not available as a vaginal suppository formulation for the treatment of vaginal candidiasis. According to clinical practice guidelines from the Infectious Diseases Society of America (IDSA), fluconazole is only administered orally for vaginal candidiasis, typically as a single 150 mg dose 1.

Available Treatment Options for Vaginal Candidiasis

First-line Treatment Options:

1. Topical antifungal agents (strong recommendation; high-quality evidence) 1

   • Various formulations available as vaginal suppositories/tablets or creams
   • No single topical agent has been shown to be superior to others

2. Oral fluconazole (strong recommendation; high-quality evidence) 1

   • Single 150 mg oral dose
   • Not available as a vaginal suppository

Treatment Selection Algorithm:

• For uncomplicated Candida vulvovaginitis:

  • Either topical antifungal agents OR
  • Single 150 mg oral dose of fluconazole 1

• For severe acute Candida vulvovaginitis:

  • Fluconazole 150 mg orally, given every 72 hours for 2-3 doses 1

• For C. glabrata vulvovaginitis (which is often azole-resistant):

  • Topical intravaginal boric acid in gelatin capsule, 600 mg daily for 14 days OR
  • Nystatin intravaginal suppositories, 100,000 units daily for 14 days OR
  • Topical 17% flucytosine cream alone or with 3% AmB cream daily for 14 days 1

• For recurring vulvovaginal candidiasis:

  • 10-14 days of induction therapy with topical agent or oral fluconazole
  • Then fluconazole 150 mg weekly for 6 months 1, 2

Clinical Efficacy Comparison

Studies have demonstrated that oral fluconazole is as effective as topical treatments:

• Single-dose oral fluconazole (150 mg) showed comparable efficacy to 7-day clotrimazole vaginal treatment, with clinical cure or improvement in 94% vs. 97% of patients at 14 days 3

• Oral fluconazole provided more rapid symptom relief compared to intravaginal clotrimazole (p<0.001) 4

• For recurrent vulvovaginal candidiasis, weekly fluconazole for 6 months kept 90.8% of women disease-free at 6 months compared to 35.9% with placebo 2

Important Clinical Considerations

• Patient preference: Many patients prefer the convenience of a single oral dose over multi-day topical treatments 5

• Pregnancy/lactation: Fluconazole is not recommended during pregnancy or lactation 5

• Diagnosis confirmation: Before treatment, diagnosis should be confirmed by wet-mount preparation with saline and 10% potassium hydroxide to demonstrate yeast or hyphae 1, 6

• Recurrent infections: Patients with a history of recurrent vaginitis are significantly less likely to respond to either oral or topical therapy 3

While fluconazole is highly effective as an oral treatment for vaginal candidiasis, it is not formulated as a vaginal suppository. For patients who cannot take oral medications or prefer a topical approach, various antifungal vaginal suppositories and creams remain available and effective options.