What are the treatment options for yeast infections, including topical creams and oral (per oral) medications?

Treatment Options for Yeast Infections: Topical Creams and Oral Medications

For yeast infections, both topical azole antifungals (creams) and oral fluconazole are effective treatment options, with success rates of 80-90% for uncomplicated cases. 1

First-Line Treatment Options

Topical (Intravaginal) Options:

• Clotrimazole 1% cream 5g intravaginally for 7-14 days 1
• Miconazole 2% cream 5g intravaginally for 7 days 1
• Clotrimazole 100mg vaginal tablet for 7 days 1
• Clotrimazole 100mg vaginal tablet, two tablets for 3 days 1
• Clotrimazole 500mg vaginal tablet, one tablet in a single application 1
• Miconazole 200mg vaginal suppository, one suppository for 3 days 1
• Tioconazole 6.5% ointment 5g intravaginally in a single application 1
• Terconazole 0.4% cream 5g intravaginally for 7 days 1
• Terconazole 0.8% cream 5g intravaginally for 3 days 1

Oral Option:

• Fluconazole 150mg oral tablet, one tablet as a single dose 1, 2

Treatment Selection Algorithm

1. For uncomplicated cases (mild to moderate symptoms, infrequent episodes):

   • Either topical azole creams for 1-7 days OR single-dose oral fluconazole 150mg 1, 3
   • Single-dose treatments should be reserved for mild-to-moderate cases 1

2. For severe or complicated cases:

   • Multi-day regimens (3-7 days) are preferred 1
   • Consider longer duration of therapy (7-14 days) 1

3. For recurrent infections (4+ episodes per year):

   • Initial intensive treatment with fluconazole 150mg every 72 hours for 3 doses 3
   • Followed by maintenance therapy (e.g., weekly fluconazole for 6 months) 4

Important Considerations

• Topical azole drugs (clotrimazole, miconazole) are more effective than nystatin for vaginal yeast infections 1, 5
• Oil-based creams and suppositories may weaken latex condoms and diaphragms 1, 3
• Self-medication with over-the-counter preparations should only be advised for women previously diagnosed with yeast infections who experience the same symptoms 1
• Any woman whose symptoms persist after using an OTC preparation or who experiences recurrence within 2 months should seek medical care 1

Special Populations

• Pregnancy: Topical azoles are preferred; fluconazole is contraindicated in the first trimester 1
• HIV infection: Standard treatment regimens are appropriate 1

Monitoring and Follow-up

• Follow-up is only necessary if symptoms persist after completing treatment or if symptoms recur within 2 months 1, 3
• Treatment of sexual partners is not routinely recommended for vulvovaginal candidiasis 3

Common Pitfalls

• Premature discontinuation of therapy can lead to treatment failure; patients should complete the full course even if symptoms improve 3
• Unnecessary or inappropriate use of OTC preparations can lead to delayed treatment of other conditions 1
• Identifying Candida in the absence of symptoms should not lead to treatment, as approximately 10-20% of women normally harbor Candida species in the vagina 1