From the Guidelines
The treatment of choice for vulvovaginal candidiasis (VVC) is topical antifungal agents or a single 150-mg oral dose of fluconazole.
Treatment Options
- Topical antifungal agents, such as clotrimazole, miconazole, and terconazole, are effective for treating VVC, with no one agent being superior to another 1.
- A single 150-mg oral dose of fluconazole is also recommended for the treatment of uncomplicated VVC 1.
Dosage and Administration
- Topical antifungal agents can be administered intravaginally, with dosing regimens varying from 3 to 14 days, depending on the specific agent and formulation 1.
- Fluconazole can be administered orally, with a single 150-mg dose being effective for treating uncomplicated VVC 1.
Recurrent VVC
- For recurrent VVC, induction therapy with a topical or oral azole for 10-14 days, followed by maintenance therapy with fluconazole 150 mg once weekly for 6 months, is recommended 1.
- Alternative maintenance regimens, such as topical clotrimazole cream or vaginal suppository, can also be used 1.
From the Research
Treatment of Vulvovaginal Candidiasis (VVC)
The treatment of choice for VVC depends on various factors, including the severity of the infection, patient preferences, and potential interactions with other medications.
- Topical therapy is recommended for most patients with acute VVC, especially for women who are pregnant, breastfeeding, or have a history of adverse reactions to oral azoles 2.
- Topical agents such as clotrimazole, miconazole, and terconazole are effective and have a high success rate of 84-90% 3, 4.
- Oral fluconazole is also an effective treatment option, but it is usually reserved for cases of recurrent VVC (RVVC) or when the benefits outweigh the potential risks 2, 5.
- The choice of treatment should be based on the specific needs of the patient, including the severity of symptoms, medical history, and potential interactions with other medications 6.
Recurrent Vulvovaginal Candidiasis (RVVC)
For women with RVVC, the treatment approach is often focused on symptomatic control rather than mycologic cure.
- Topical maintenance therapy with agents such as clotrimazole, miconazole, and terconazole is a recommended approach for RVVC 5.
- The frequency of topical applications can vary, but twice a week dosing is a common regimen 5.
- Oral fluconazole can also be used for maintenance therapy, but it is usually reserved for cases where topical therapy is not feasible or effective 5.