What is the treatment for vulvovaginal candidiasis (VVC) during pregnancy?

From the Guidelines

To treat a yeast infection during pregnancy, start with over-the-counter antifungal vaginal creams or suppositories containing clotrimazole or miconazole, and use them for 7 days as recommended by the most recent guidelines 1. The treatment of yeast infections during pregnancy is crucial to prevent complications and ensure the health of both the mother and the fetus.

• The medications of choice are topical azole therapies, which have been shown to be effective and safe for use during pregnancy 1.
• Clotrimazole and miconazole are the most commonly recommended medications, and they are available over-the-counter in various formulations, including creams and suppositories.
• The 7-day treatment course is recommended for pregnant women, as it provides the same effectiveness with lower doses of medication 1.
• It is essential to follow the instructions on the package and apply the cream or insert the suppository as directed, usually at bedtime.
• Oral antifungal medications like fluconazole should be avoided during pregnancy due to potential risks to the developing baby 1.
• To help prevent recurrence, it is recommended to wear cotton underwear, avoid tight clothing, wipe from front to back after using the bathroom, and avoid douches or scented feminine products.
• If symptoms do not improve after completing an over-the-counter treatment, or if frequent infections occur, it is crucial to consult a healthcare provider for further evaluation and guidance.

From the FDA Drug Label

If you are taking any of these drugs do not stop taking them without first asking a doctor. If you have any other medical questions or concerns about vaginal yeast infections, call your doctor. If pregnant or breast-feeding, ask a health professional before use.

Treatment of yeast infection in pregnancy should be done under the guidance of a healthcare professional.

• The FDA drug label for miconazole 2 advises to ask a health professional before use if pregnant or breast-feeding.
• The label does not provide explicit instructions for treating yeast infections during pregnancy, but it emphasizes the importance of consulting a doctor for any medical questions or concerns.
• It is crucial to follow the advice of a healthcare professional for proper diagnosis and treatment.

From the Research

Treatment Options for Yeast Infection in Pregnancy

• Miconazole nitrate administered intravaginally has been found to achieve comparable therapeutic and mycological cure rates in both pregnant and nonpregnant women 3.
• Miconazole nitrate is significantly better than nystatin, clotrimazole, and butoconazole in treating vaginal candidiasis during gestation 3.
• Nystatin and clotrimazole were equivalent to miconazole in curing vaginal candidiasis, but significantly more patients relapsed in the nystatin and clotrimazole groups than in the miconazole groups 4.

Comparison of Antifungal Drugs

• Clotrimazole, nystatin, and miconazole were the most studied topical drugs and demonstrated similar efficacy with complete cure rates of 73%-100% 5.
• Oral fluconazole demonstrated similar efficacy to oral ketoconazole and topical clotrimazole in the treatment of cutaneous candidiasis 5.
• A Bayesian network meta-analysis showed that itraconazole capsules, itraconazole oral solution, miconazole buccal tablets, miconazole oral gel, clotrimazole, fluconazole, ketoconazole, nystatin, and amphotericin B were better than a placebo in reducing the mycological cure rate in oral candidiasis 6.

Efficacy of Antifungal Drugs

• Miconazole oral gel, fluconazole, and ketoconazole were better than nystatin in reducing the mycological cure rate in oral candidiasis 6.
• The effect of fluconazole in reducing the risk of the mycological cure rate in oral candidiasis was better than that of other drugs 6.
• Nystatin and miconazole are the most commonly used topical antifungal drugs, and both are very effective but need a long time of use to eradicate the infection 7.