What is the recommended treatment for a yeast infection?

Treatment for Yeast Infection

For uncomplicated Candida vulvovaginitis, either topical antifungal agents or a single 150-mg oral dose of fluconazole is recommended as first-line treatment. 1

Treatment Options Based on Infection Type

Uncomplicated Vulvovaginal Candidiasis (90% of cases)

• Topical antifungal options (all equally effective) 1:

  • Clotrimazole 1% cream 5g intravaginally for 7-14 days 1
  • Clotrimazole 100mg vaginal tablet for 7 days 1
  • Clotrimazole 100mg vaginal tablet, two tablets for 3 days 1
  • Clotrimazole 500mg vaginal tablet, single application 1
  • Miconazole 2% cream 5g intravaginally for 7 days 1
  • Miconazole 200mg vaginal suppository, one suppository for 3 days 1
  • Miconazole 100mg vaginal suppository, one suppository for 7 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
  • Terconazole 80mg suppository, one suppository for 3 days 1

• Oral option:

  • Fluconazole 150mg single oral dose 1

Severe Acute Vulvovaginal Candidiasis

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

Non-albicans Candida Species (C. glabrata)

• For C. glabrata infections unresponsive to oral azoles:
  • Boric acid 600mg in gelatin capsule, intravaginally daily for 14 days 1
  • Nystatin intravaginal suppositories, 100,000 units daily for 14 days 1
  • Topical 17% flucytosine cream alone or with 3% AmB cream daily for 14 days 1

Recurrent Vulvovaginal Candidiasis

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

Treatment Algorithm

1. Determine type of infection:

   • Uncomplicated (90% of cases): Typical symptoms with C. albicans in healthy host 1
   • Complicated (10% of cases): Severe symptoms, non-albicans species, abnormal host, or recurrent infection 1

2. For uncomplicated infection:

   • Choose either topical antifungal for 1-7 days OR single oral fluconazole 150mg 1
   • Patient preference may guide choice - topicals provide faster symptomatic relief but oral treatment is more convenient 1

3. For severe infection:

   • Use fluconazole 150mg every 72 hours for 2-3 doses 1

4. For non-albicans species:

   • Try boric acid 600mg intravaginally daily for 14 days 1

5. For recurrent infections:

   • Initial intensive treatment followed by maintenance therapy with fluconazole 150mg weekly for 6 months 1

Important Clinical Considerations

• Diagnosis should be confirmed with wet mount preparation using saline and 10% potassium hydroxide to demonstrate yeast or hyphae 1
• Vaginal pH is typically normal (<4.5) in Candida infections 1
• Self-diagnosis of yeast infections is often inaccurate - patients with persistent symptoms despite OTC treatment should seek medical care 1
• Approximately 10-20% of women normally harbor Candida species in the vagina without symptoms - treatment is not indicated without symptoms 1
• For denture-related oral candidiasis, disinfection of the denture in addition to antifungal therapy is recommended 1
• Pregnant women should avoid fluconazole in the first trimester 1

Treatment Efficacy and Follow-up

• Treatment with azoles results in relief of symptoms and negative cultures in 80-90% of patients 1
• Single-dose treatments should be reserved for mild-to-moderate uncomplicated cases 1
• Multi-day regimens (3 and 7-day) are preferred for severe or complicated infections 1
• Patients should be advised to complete the full course of treatment even if symptoms resolve earlier 2
• Recurrence within 2 months after treatment warrants medical evaluation 1