From the Guidelines
For the treatment of vulvovaginal candidiasis, Monistat (miconazole) is recommended with different dosing options, including a one-time application of 1200mg, three daily applications of 200mg, or seven daily applications of 100mg, as outlined in the 2021 Centers for Disease Control and Prevention guidelines 1.
Treatment Options
The choice of dosing regimen may depend on the severity of the infection and patient preference.
- Monistat 1: one-time application of 1200mg miconazole nitrate
- Monistat 3: three daily applications of 200mg
- Monistat 7: seven daily applications of 100mg It is essential to complete the full course of treatment, even if symptoms improve before finishing, to ensure effective treatment of the infection.
Administration and Side Effects
Apply the medication intravaginally at bedtime using the provided applicator, following package instructions carefully. Side effects may include mild burning, itching, or irritation. If symptoms persist after treatment, if you have recurrent infections (4+ per year), or if you're pregnant, consult a healthcare provider before using Monistat 1. Avoid using tampons during treatment as they may absorb the medication.
Diagnosis and Treatment
The diagnosis of vulvovaginal candidiasis can be made through microscopy, clinical suspicion, or culture, with molecular testing emerging as a promising diagnostic tool 1. Treatment with azoles, such as miconazole, results in relief of symptoms and negative cultures in 80%--90% of patients who complete therapy 1. It is crucial to note that unnecessary or inappropriate use of over-the-counter preparations can lead to delay of treatment of other etiologies of vulvovaginitis, resulting in adverse clinical outcomes 1.
From the FDA Drug Label
Directions before using this product read the enclosed educational brochure for complete directions and information adults and children 12 years of age and over: vaginal cream:insert one applicatorful of cream into the vagina at bedtime for 3 days in a row. Throw applicator away after use.
- Vaginal Cream Dosing: Insert one applicatorful of cream into the vagina at bedtime for 3 days in a row.
- External Cream Dosing: Apply a small amount of cream to itchy, irritated skin outside the vagina 2 times daily for up to 7 days as needed.
- Pediatric Dosing: For children under 12 years of age, dosing instructions are to ask a doctor 2
From the Research
Monostat Dosing
- Monostat is a brand name for clotrimazole, an antifungal medication used to treat vulvovaginal candidiasis (VVC) 3, 4, 5.
- The typical dosing for Monostat is a single 500mg vaginal tablet, which has been shown to be effective in treating VVC 4, 5.
- Studies have compared the efficacy of single-dose and multiple-dose clotrimazole regimens, with results showing that single-dose treatment is as effective as multiple-dose treatment 4, 5.
- A single dose of clotrimazole 500mg has been shown to be equipotent to multiple doses of lower dose strengths 3.
- Prolonged treatment regimens with clotrimazole have been shown to be effective in severe and recurrent cases of VVC, as well as in symptomatic pregnant women 3.
Treatment Outcomes
- Clinical trials have demonstrated that clotrimazole is effective in treating VVC, with cure rates ranging from 65% to 90% 4, 5.
- A study comparing clotrimazole to chamomile extract cream found that both treatments were effective in reducing symptoms of VVC, with no significant difference in recovery rates between the two groups 6.
- The addition of probiotic Lacidophilin Vaginal Capsules to clotrimazole treatment has been shown to improve treatment outcomes in uncomplicated VVC, with a cure rate of 72.73% 7.
Safety and Efficacy
- Clotrimazole has been shown to be safe and effective in the treatment of VVC, with few reported adverse effects 4, 5.
- The use of clotrimazole in combination with probiotic Lacidophilin Vaginal Capsules has been shown to improve the composition of vaginal flora and restore vaginal microecology, potentially leading to improved treatment outcomes 7.