What is the recommended treatment for a yeast infection?

Treatment for Yeast Infections

For uncomplicated vaginal yeast infections (vulvovaginal candidiasis), a single 150-mg oral dose of fluconazole or topical antifungal agents are equally effective and recommended as first-line therapy. 1, 2

First-Line Treatment Options

Oral Therapy

• Fluconazole 150 mg single oral dose
  • Advantages: Convenience, single dose, high patient acceptability 2, 3
  • Clinical efficacy rates: 92-99% at short-term evaluation 3
  • Well-tolerated with mostly mild gastrointestinal side effects 4, 3

Topical Therapy Options

• Clotrimazole vaginal cream/tablets (2% cream for 3 days) 5
• Miconazole vaginal suppositories/cream
• Nystatin vaginal tablets

Both treatment approaches show similar efficacy rates, with clinical cure or improvement in 94% of fluconazole-treated patients and 97% of clotrimazole-treated patients at 14-day evaluation 6.

Treatment for Severe Acute Vulvovaginal Candidiasis

• Fluconazole 150 mg every 72 hours for a total of 2-3 doses 1, 2

Treatment for Non-albicans Candida Species (e.g., C. glabrata)

For C. glabrata infections unresponsive to oral azoles:

1. Topical intravaginal boric acid 600 mg daily for 14 days 1, 2
2. Nystatin intravaginal suppositories 100,000 units daily for 14 days 1, 2
3. Topical 17% flucytosine cream alone or with 3% AmB cream daily for 14 days 1, 2

Treatment for Recurrent Vulvovaginal Candidiasis

• Initial treatment: 10-14 days of induction therapy with topical agent or oral fluconazole
• Followed by maintenance therapy: Fluconazole 150 mg weekly for 6 months 1, 2

Clinical Considerations

• Patients with a history of recurrent vaginitis are significantly less likely to respond to treatment (p<0.001) 6
• At 35-day evaluation, approximately 75% of patients remain clinically cured with either oral fluconazole or topical treatment 6
• Patient preference often favors oral administration over local therapy 7

Contraindications for Fluconazole

Do not use fluconazole if the patient:

• Takes quinidine, erythromycin, or pimozide
• Has a known allergy to fluconazole or its ingredients
• Is pregnant or breastfeeding (not recommended) 4, 7

Treatment Selection Factors

• Severity of infection
• History of recurrent infections
• Suspected or confirmed Candida species
• Patient preference
• Pregnancy status

Oral fluconazole provides a convenient single-dose option with high efficacy rates comparable to traditional topical treatments, making it an excellent first-line choice for uncomplicated vaginal yeast infections.