Albendazole is NOT Indicated for Vulvovaginal Candidiasis
Albendazole is an antiparasitic medication used exclusively for helminthic (worm) infections and has no role in treating vulvovaginal candidiasis, which is a fungal infection requiring antifungal therapy. 1
Albendazole: Approved Indications
Albendazole is FDA-approved specifically for parasitic infections, not fungal infections:
Hydatid disease (echinococcosis): 400 mg twice daily with meals for patients ≥60 kg, given in 28-day cycles followed by 14-day drug-free intervals, for a total of 3 cycles 1
Neurocysticercosis: 400 mg twice daily with meals for patients ≥60 kg, administered for 8-30 days with concurrent steroid and anticonvulsant therapy 1
Other parasitic infections: Albendazole demonstrates efficacy against intestinal nematodes (ascariasis, hookworm, trichuriasis, strongyloidiasis, enterobiasis), intestinal tapeworms, tissue nematode/cestode infections, and certain filarial infections 2
Critical Safety Monitoring for Albendazole
If albendazole is prescribed for a parasitic infection, mandatory monitoring includes:
Bone marrow suppression surveillance: Monitor complete blood counts at the beginning of each 28-day cycle and every 2 weeks during therapy, as fatalities from granulocytopenia and pancytopenia have been reported 1
Hepatotoxicity monitoring: Check liver enzymes (transaminases) before each treatment cycle and at least every 2 weeks during treatment; discontinue if enzymes exceed twice the upper limit of normal 1
Pregnancy testing: Obtain pregnancy test in females of reproductive potential prior to therapy, as albendazole causes embryotoxicity and skeletal malformations in animal studies 1
Contraception requirement: Advise females of reproductive potential to use effective contraception during treatment and for 3 days after the final dose 1
Correct Treatment for Recurrent Vulvovaginal Candidiasis
For the patient with recurrent vulvovaginal candidiasis described in your question, the appropriate management is:
Initial Diagnostic Confirmation
- Confirm diagnosis with wet-mount preparation using 10% potassium hydroxide to demonstrate yeast or hyphae, and verify normal vaginal pH (4.0-4.5) 3, 4
- Obtain vaginal cultures to identify the specific Candida species, particularly to rule out C. glabrata which demonstrates azole resistance 3, 5
Induction Therapy
- For uncomplicated infection: Fluconazole 150 mg orally as a single dose, or fluconazole 150 mg every 72 hours for 3 doses (total of 3 doses) 3
- For recurrent vulvovaginal candidiasis (≥4 episodes per year): Begin with induction therapy using topical azole for 10-14 days OR oral fluconazole for 10-14 days 3
Maintenance Therapy
- After achieving initial control: Fluconazole 150 mg orally once weekly for at least 6 months achieves symptom control in >90% of patients 3, 4, 6
- Alternative maintenance regimens: Clotrimazole 200 mg intravaginally twice weekly or clotrimazole 500 mg vaginal suppository once weekly 3
Special Considerations for Non-Albicans Species
- For C. glabrata infections: Boric acid 600 mg in gelatin capsule intravaginally daily for 14 days is first-line therapy, as this species demonstrates reduced azole susceptibility 5
- For azole-refractory cases: Topical 17% flucytosine cream alone or combined with 3% amphotericin B cream for 14 days 3, 5
Common Pitfall to Avoid
The most critical error would be prescribing albendazole for a fungal infection. Albendazole has zero antifungal activity and works exclusively by disrupting parasite microtubule systems 2. Using albendazole for candidiasis would expose the patient to serious risks (bone marrow suppression, hepatotoxicity, teratogenicity) without any therapeutic benefit 1.