What is the recommended treatment for a yeast infection?

Treatment of Yeast Infection

For uncomplicated vulvovaginal candidiasis, use topical azole antifungals (clotrimazole, miconazole, or others) for 3-7 days, or oral fluconazole 150 mg as a single dose. 1, 2

First-Line Treatment Options

Topical Azole Therapy (Preferred for Uncomplicated Cases)

The following intravaginal formulations are equally effective, with 80-90% cure rates 1:

Short-course regimens (3 days):

• Clotrimazole 100 mg vaginal tablet, two tablets daily for 3 days 1
• Miconazole 200 mg vaginal suppository, one daily for 3 days 1, 3
• Butoconazole 2% cream 5g intravaginally for 3 days 1
• Terconazole 0.8% cream 5g intravaginally for 3 days 1

Standard regimens (7 days):

• Clotrimazole 1% cream 5g intravaginally for 7 days 1, 3
• Miconazole 2% cream 5g intravaginally for 7 days 1
• Clotrimazole 100 mg vaginal tablet daily for 7 days 1

Single-dose option:

• Clotrimazole 500 mg vaginal tablet, one application 1
• Tioconazole 6.5% ointment 5g intravaginally, single application 1

Oral Azole Therapy (Alternative)

• Fluconazole 150 mg orally as a single dose 2, 4
• This is the only oral tablet option and provides systemic treatment 2
• Achieves clinical cure rates of approximately 66.6% 4

Clinical Decision Algorithm

Use multi-day regimens (3-7 days) for:

• Severe or complicated vulvovaginal candidiasis 1
• First episode of infection
• Immunocompromised patients

Reserve single-dose treatments for:

• Uncomplicated mild-to-moderate cases only 1
• Previously diagnosed patients with recurrent symptoms 1

Choose oral fluconazole when:

• Patient preference for oral therapy
• Difficulty with intravaginal administration
• Need for systemic treatment 2

Important Clinical Considerations

Diagnostic Confirmation

• Diagnosis requires signs/symptoms PLUS demonstration of yeasts or pseudohyphae on wet preparation or positive culture 1
• Normal vaginal pH (≤4.5) supports Candida diagnosis 1
• Do not treat asymptomatic colonization - 10-20% of women normally harbor Candida species 1

Common Pitfalls to Avoid

• Topical azoles are more effective than nystatin - avoid using nystatin as first-line therapy 1
• Single-dose treatments have higher failure rates in severe infections 1
• Over-the-counter preparations (miconazole, clotrimazole) should only be used by women previously diagnosed with VVC 1

When to Seek Further Evaluation

• Symptoms persist after OTC treatment 1
• Recurrence within 2 months 1
• Recurrent infections (>4 episodes per year) may require longer suppressive therapy 1

Special Populations

Pregnancy:

• Fluconazole is contraindicated in first trimester 1
• Use topical azole therapy instead 1
• If oral therapy needed after first trimester, use with caution 1, 2
• Women of childbearing potential should use contraception during fluconazole treatment and for 1 week after 2

HIV/Immunocompromised:

• May require oral azole therapy (fluconazole, itraconazole) for adequate response 5
• Higher risk of recurrence and azole resistance 6

Drug Interactions and Contraindications

Do not use fluconazole with: 2

• Quinidine
• Erythromycin
• Pimozide

Use caution in patients with: 2

• Liver disease
• Kidney disease
• Heart arrhythmias
• Hypokalemia