From the Guidelines
The latest recommendation for chronic vulvovaginal candidiasis (VVC) treatment involves a 10-14 day induction therapy with a topical agent or oral fluconazole, followed by fluconazole 150 mg weekly for 6 months. This approach is based on the strong recommendation and high-quality evidence from the 2016 update by the Infectious Diseases Society of America 1. The treatment strategy is designed to address the recurring nature of VVC, which is often caused by Candida albicans.
Key aspects of the treatment include:
- Induction therapy with a topical agent or oral fluconazole for 10-14 days to reduce the fungal load
- Maintenance therapy with fluconazole 150 mg weekly for 6 months to prevent recurrence
- Addressing predisposing factors such as diabetes control, avoiding unnecessary antibiotics, and discontinuing unnecessary hormonal contraception
- Practicing lifestyle changes such as wearing cotton underwear, avoiding tight clothing, and using non-perfumed hygiene products to prevent recurrence
It is essential to note that partners generally do not require treatment unless they have symptoms, as sexual transmission is not the primary mechanism for recurrent infection. By following this recommended treatment approach, women with chronic VVC can experience significant improvement in their symptoms and quality of life, as supported by the high-quality evidence from the Infectious Diseases Society of America 1.
From the FDA Drug Label
The recommended dosage of fluconazole tablets for vaginal candidiasis is 150 mg as a single oral dose. The latest recommendation for chronic vulvovaginal candidiasis (VVC) treatment is not explicitly stated in the provided drug labels. However, for vaginal candidiasis, the recommended dosage of fluconazole is 150 mg as a single oral dose.
- Key points:
- The provided drug labels do not directly address the treatment of chronic VVC.
- The recommended dosage for vaginal candidiasis is 150 mg as a single oral dose.
- No conclusion can be drawn for the treatment of chronic VVC based on the provided information 2.
From the Research
Treatment Options for Chronic Vulvovaginal Candidiasis (VVC)
- The latest recommendation for chronic VVC treatment involves an initial full course of treatment followed by topical maintenance, with the frequency of application depending on the chosen agent 3.
- Topical agents such as clotrimazole, miconazole, terconazole, and intravaginal boric acid are suggested for recurrent vulvovaginitis caused by both Candida albicans and non-albicans species 3.
- Nystatin ovules may not be as effective as azoles, and identification of the species will influence treatment decisions 3.
- Fluconazole, ibrexafungerp, and intravaginal boric acid should be avoided during pregnancy 3.
Comparison of Treatment Regimens
- A single oral dose of fluconazole has been shown to be as effective as 7-day clotrimazole vaginal treatment for acute Candida vaginitis 4.
- Imidazole agents (clotrimazole, miconazole, butoconazole, and terconazole) are preferred for the treatment of vulvovaginal candidiasis due to their greater efficacy, shorter treatment regimens, and ease of administration 5.
- The in vitro susceptibility profile of recent clinical isolates of Candida spp. to topical antifungal treatments has been studied, with results confirming the susceptibility of C. albicans to the most frequently used topical agents 6.
Considerations for Treatment
- The treatment of vulvovaginal candidosis should be individualized, taking into consideration the severity of disease, history of recurrent vaginitis, and patient preference 4.
- Host factors, particularly local defense mechanisms, gene polymorphisms, allergies, serum glucose levels, antibiotics, psycho-social stress, and oestrogens, influence the risk of candidal vulvovaginitis 7.
- Medical history, clinical examination, and microscopic examination of vaginal content are essential for diagnosis, and fungal culture for pathogen determination should be performed in clinically and microscopically unclear cases or in chronically recurring cases 7.