From the Guidelines
For the treatment of vulvovaginal candidiasis, the most effective vaginal suppository options include Miconazole 100 mg or 200 mg vaginal suppository, with treatment durations of 7 or 3 days, respectively, as recommended by the 2021 Centers for Disease Control and Prevention guidelines 1.
Treatment Options
The following are the recommended regimens for the treatment of vulvovaginal candidiasis:
- Miconazole 100 mg vaginal suppository, one suppository daily for 7 days
- Miconazole 200 mg vaginal suppository, one suppository for 3 days
- Miconazole 1200 mg vaginal suppository, one suppository for 1 day
- Clotrimazole 1% cream, 5 g intravaginally daily for 7–14 days
- Clotrimazole 2% cream, 5 g intravaginally daily for 3 days
- Terconazole 80 mg vaginal suppository, one suppository daily for 3 days
Important Considerations
When using suppositories, it is essential to:
- Continue the full treatment course even if symptoms improve early
- Avoid douching
- Wear cotton underwear
- Abstain from sexual intercourse during treatment These medications work by disrupting the fungal cell membrane, preventing the yeast from growing and reproducing. If symptoms persist after treatment, or if you experience frequent infections, consult a healthcare provider as this could indicate a different condition or an underlying health issue 1.
From the FDA Drug Label
Miconazole Nitrate Vaginal Insert (1200 mg) Cures Most Vaginal Yeast Infections and Relieves Associated External Itching and Irritation This product contains a 1-dose vaginal insert that cures most vaginal yeast infections, plus an external cream that can be used for relief of itching and irritation on the skin outside the vagina (vulva) due to a yeast infection.
The options for vaginal suppository treatment of vulvovaginal candidiasis (yeast infection) include:
- Miconazole vaginal insert (1200 mg) 2
- Terconazole vaginal cream 0.4% is indicated for the local treatment of vulvovaginal candidiasis (moniliasis) 3
From the Research
Vaginal Suppository Treatment Options
The following options are available for vaginal suppository treatment of vulvovaginal candidiasis:
- Imidazole agents, such as clotrimazole, miconazole, butoconazole, and terconazole, which are preferred due to their greater efficacy, shorter treatment regimens, and ease of administration 4
- Butoconazole vaginal suppositories (100 mg/day) for 3 days, which have been found to be comparably safe and effective to clotrimazole vaginal tablets (200 mg/day) 5
- Clotrimazole vaginal tablets (200 mg/day) for 3 or 7 days, which have been shown to be effective in treating vulvovaginal candidiasis 5, 6
- Other vaginal preparations, such as nystatin, ketoconazole, and itraconazole, which are also available for treatment 7, 8
Treatment Efficacy
The efficacy of these treatment options varies, but most have been shown to be effective in treating vulvovaginal candidiasis:
- Butoconazole 2% cream has been found to have comparable microbiologic and clinical cure rates to miconazole nitrate 2% cream and clotrimazole vaginal tablets 5
- Clotrimazole 1% vaginal cream has been shown to have a slightly better efficacy than miconazole nitrate 2% vaginal cream, with no adverse reactions and in half the treatment time 6
- Fluconazole, an oral drug, has been found to be effective for continuous treatment of vaginal yeast infection with the least toxicity 8
Treatment Duration
The duration of treatment also varies, but most options are effective with short treatment regimens:
- 3-day treatment with butoconazole 2% cream or clotrimazole vaginal tablets (200 mg/day) has been found to be effective 5
- 7-day treatment with clotrimazole 1% vaginal cream has been shown to be effective 6
- Longer treatment regimens, such as 14-day treatment with miconazole nitrate 2% vaginal cream, are also available 6