What is the treatment for vaginal candidiasis (Vaginal Yeast Infection)?

From the Guidelines

Vaginal candidiasis should be treated with antifungal medications, with fluconazole 150 mg as a single dose being a highly effective option for uncomplicated cases, as supported by the most recent evidence from 1. For uncomplicated cases, treatment options include:

• Topical azoles like clotrimazole (1% cream applied intravaginally for 7 days or 2% cream for 3 days)
• Miconazole (2% cream for 7 days or 4% cream for 3 days)
• Fluconazole (150 mg oral tablet as a single dose) These medications work by disrupting the fungal cell membrane, preventing the yeast from growing and reproducing. For severe or recurrent infections, a longer course of treatment may be necessary, such as fluconazole 150 mg taken orally every 72 hours for three doses, followed by weekly doses for 6 months for maintenance therapy in recurrent cases, as recommended by 1. During treatment, it's essential to avoid irritants like scented soaps or douches, wear breathable cotton underwear, and avoid tight-fitting clothing. Sexual partners generally don't need treatment unless they show symptoms. Most women experience relief within a few days of starting treatment, though it's crucial to complete the full course even if symptoms resolve earlier to prevent recurrence, as noted in 1. The diagnosis of vulvovaginal candidiasis can be made clinically, but confirmation with a wet-mount preparation or culture may be necessary in some cases, as discussed in 1. Overall, the treatment of vaginal candidiasis should be guided by the severity and frequency of symptoms, as well as the presence of any underlying medical conditions, with the goal of alleviating symptoms and preventing recurrence, as emphasized in 1 and 1.

From the FDA Drug Label

Vaginal candidiasis: Two adequate and well-controlled studies were conducted in the U. S. using the 150 mg tablet. In both, the results of the fluconazole regimen were comparable to the control regimen (clotrimazole or miconazole intravaginally for 7 days) both clinically and statistically at the one month post-treatment evaluation The therapeutic cure rate, defined as a complete resolution of signs and symptoms of vaginal candidiasis (clinical cure), along with a negative KOH examination and negative culture for Candida (microbiologic eradication), was 55% in both the fluconazole group and the vaginal products group Fluconazole PO 150 mg tablet Vaginal Product qhs x 7 days Enrolled 448 422 Evaluable at Late Follow-up 347 (77%) 327 (77%) Clinical cure 239/347 (69%) 235/327 (72%) Mycologic eradication 213/347 (61%) 196/327 (60%) Therapeutic cure 190/347 (55%) 179/327 (55%)

The treatment for vaginal candidiasis is fluconazole (PO) with a therapeutic cure rate of 55%.

• Clinical cure: 69%
• Mycologic eradication: 61%
• Therapeutic cure: 55% 2

From the Research

Treatment Options for Vaginal Candidiasis

• Various treatment options are available for vaginal candidiasis, including systemic and topical therapies 3, 4, 5, 6.
• Systemic therapy with oral fluconazole has been shown to be effective in treating vaginal candidiasis, with a single oral dose of 150mg being more effective than intravaginal clotrimazole in some studies 5.
• Topical therapy with imidazole agents such as clotrimazole, miconazole, butoconazole, and terconazole is also effective, with different treatment schedules recommended depending on clinical situations 4.
• A combined treatment approach using both systemic and topical therapies, along with adjuvant oral probiotic therapy, has been proposed as a new therapeutic approach to recurrent vulvovaginal candidiasis 3.

Antimycotic Agents

• Various antimycotic agents are available for the treatment of vaginal candidiasis, including polyenes, imidazoles, and triazoles 6.
• Clotrimazole, an imidazole agent, is commonly used for the treatment of vaginal candidiasis, and can be administered intravaginally or orally 4, 5.
• Fluconazole, a triazole agent, is also effective in treating vaginal candidiasis, and can be administered orally 5, 6.

Resistance and Recurrence

• Resistance to antimycotic agents is a concern in the treatment of vaginal candidiasis, particularly with the use of triazoles such as fluconazole 6.
• Recurrence of vaginal candidiasis is common, and suppressive therapy with oral fluconazole has been shown to be effective in reducing the rate of recurrence 6.
• New therapeutic agents such as essential oils, probiotics, and antimicrobial peptides are being investigated as potential treatments for vaginal candidiasis, particularly in cases of resistance or recurrence 7.

Advanced Formulations

• Advanced solid formulations such as intravaginal rings, vaginal films, sponges, and nanofibers are being developed as potential treatments for vaginal candidiasis 7.
• These formulations aim to provide a more sustained and controlled release of antimycotic agents, reducing the need for frequent administration and improving patient compliance 7.