What is the recommended dosing regimen for Terconazole (antifungal medication) in treating vaginal yeast infections?

Terconazole Dosing and Regimen for Vulvovaginal Candidiasis

For uncomplicated vulvovaginal candidiasis, terconazole is administered as either 0.4% cream 5g intravaginally daily for 7 days, 0.8% cream 5g intravaginally daily for 3 days, or 80mg vaginal suppository once daily for 3 days. 1, 2

Standard Dosing Regimens

The CDC-recommended terconazole formulations include:

• Terconazole 0.4% cream: 5g intravaginally once daily at bedtime for 7 consecutive days 1, 2
• Terconazole 0.8% cream: 5g intravaginally once daily for 3 days 1
• Terconazole 80mg vaginal suppository: One suppository intravaginally once daily for 3 days 1

Administration Guidelines

Timing and technique matter for optimal efficacy:

• Administer at bedtime to maximize vaginal retention and minimize leakage 2
• Use one full applicator (5g) for cream formulations 2
• Treatment can continue through menstruation without affecting therapeutic efficacy 2
• Oil-based formulations may weaken latex condoms and diaphragms during treatment 1

Clinical Efficacy

Terconazole demonstrates high cure rates across multiple studies:

• Clinical cure rates range from 87-96% at 8-10 days post-therapy 3, 4
• Mycologic cure rates range from 77-91% at early follow-up 3, 4
• The 3-day suppository regimen (80mg) shows comparable efficacy to 7-day miconazole therapy, with clinical cure rates of 90-92% 3, 4

Follow-Up and Retreatment

Patients require follow-up only if symptoms persist or recur:

• Return visits are indicated only for persistent symptoms or recurrence within 2 months 1
• Before prescribing a second course, reconfirm diagnosis with microscopy and/or culture to rule out other pathogens 2
• Relapse rates at 30-35 days range from 10-28% depending on formulation 3

Important Clinical Considerations

Common pitfalls to avoid:

• Do not use concentrations like "0.1mg" - this represents a dosing error, as terconazole comes only in the standardized concentrations listed above 5
• Do not extend treatment beyond 7 days for uncomplicated cases - prolonged courses (e.g., 4 weeks) exceed standard recommendations even for complicated VVC 5
• Treatment of sexual partners is not routinely recommended, as VVC is not sexually transmitted 1

Safety Profile

Terconazole is generally well-tolerated with minimal adverse effects:

• Local burning or irritation may occur but is typically mild 1
• Systemic side effects are rare with intravaginal administration 1
• Rare case reports document systemic reactions including chills, fatigue, and elevated inflammatory markers, which resolve with drug removal and supportive care 6