Template:Candidiasis Treatment: Difference between revisions
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====Uncomplicated==== | ====Uncomplicated==== | ||
''There is little resistance to azole medications; treatment often dictated by patient preference.'' | ''There is little resistance to azole medications; treatment often dictated by patient preference.'' | ||
* | *{{AntibioticDose|disease=Candida vulvovaginitis|drug=Fluconazole|dose=150mg PO once|context=Preferred; a second dose at 72hrs may be given if still symptomatic}}<ref name=management>Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.</ref> | ||
*Intravaginal therapy | *Intravaginal therapy | ||
** | **{{AntibioticDose|disease=Candida vulvovaginitis|drug=Clotrimazole|dose=1% cream applied vaginally for 7 days OR 2% applied vaginally for 3 days|context=Intravaginal therapy}} | ||
**{{AntibioticDose|disease=Candida vulvovaginitis|drug=Miconazole|dose=2% cream applied vaginally for 7 days OR 4% cream x 3 days|context=Intravaginal therapy}} | |||
** | |||
**Butoconazole 2% applied vaginally x 3 days | **Butoconazole 2% applied vaginally x 3 days | ||
**Tioconazole 6.5% applied vaginally x 1 | **Tioconazole 6.5% applied vaginally x 1 | ||
====Complicated==== | ====Complicated==== | ||
<u>Severe or immunosuppressed</u> | <u>Severe or immunosuppressed</u> | ||
* | *{{AntibioticDose|disease=Candida vulvovaginitis|drug=Fluconazole|dose=150mg PO q72h x 3 doses|context=Severe or immunosuppressed}} | ||
<u>Non-albicans species</u> | |||
<u>Non-albicans species</u> | |||
*For example, C. glabrata, C. krusei and other atypical Candida spp. | *For example, C. glabrata, C. krusei and other atypical Candida spp. | ||
*Boric acid vaginal suppository intravaginal qday x ≥14 days | *Boric acid vaginal suppository intravaginal qday x ≥14 days | ||
**Can be fatal if taken orally | **Can be fatal if taken orally | ||
*If empirically treated and later is found to have non-albicans Candida spp., no change in therapy is needed if patient is improving (otherwise switch to boric acid. | *If empirically treated and later is found to have non-albicans Candida spp., no change in therapy is needed if patient is improving (otherwise switch to boric acid. | ||
<u>Recurrent (≥ 4 infections in a year)</u> | <u>Recurrent (≥ 4 infections in a year)</u> | ||
*Treat as for uncomplicated (see above) | *Treat as for uncomplicated (see above) | ||
*Once therapy completed, prescribe long-term treatment | *Once therapy completed, prescribe long-term treatment | ||
** | **{{AntibioticDose|disease=Candida vulvovaginitis|drug=Fluconazole|dose=150mg PO qweek x 6 months|context=Recurrent; long-term suppressive therapy}} OR | ||
**Intravaginal medication, such as clotrimazole 500mg PV qweek or 200mg PV twice a week | **Intravaginal medication, such as clotrimazole 500mg PV qweek or 200mg PV twice a week | ||
====Pregnant Patients==== | ====Pregnant Patients==== | ||
*Intravaginal [[clotrimazole]] or [[miconazole]] are the only recommended treatments | |||
*Intravaginal [[ | |||
*Duration is 7 days | *Duration is 7 days | ||
*PO fluconazole associated with congenital malformations and spontaneous abortions<ref>Molgaard-Nielsen D et al. Association Between Use of Oral Fluconazole During Pregnancy and Risk of Spontaneous Abortion and Stillbirth. JAMA. 2016;315(1):58-67.</ref> | *PO fluconazole associated with congenital malformations and spontaneous abortions<ref>Molgaard-Nielsen D et al. Association Between Use of Oral Fluconazole During Pregnancy and Risk of Spontaneous Abortion and Stillbirth. JAMA. 2016;315(1):58-67.</ref> | ||
Latest revision as of 02:24, 20 March 2026
Uncomplicated
There is little resistance to azole medications; treatment often dictated by patient preference.
- Fluconazole 150mg PO once[1]
- Intravaginal therapy
- Clotrimazole 1% cream applied vaginally for 7 days OR 2% applied vaginally for 3 days
- Miconazole 2% cream applied vaginally for 7 days OR 4% cream x 3 days
- Butoconazole 2% applied vaginally x 3 days
- Tioconazole 6.5% applied vaginally x 1
Complicated
Severe or immunosuppressed
- Fluconazole 150mg PO q72h x 3 doses
Non-albicans species
- For example, C. glabrata, C. krusei and other atypical Candida spp.
- Boric acid vaginal suppository intravaginal qday x ≥14 days
- Can be fatal if taken orally
- If empirically treated and later is found to have non-albicans Candida spp., no change in therapy is needed if patient is improving (otherwise switch to boric acid.
Recurrent (≥ 4 infections in a year)
- Treat as for uncomplicated (see above)
- Once therapy completed, prescribe long-term treatment
- Fluconazole 150mg PO qweek x 6 months OR
- Intravaginal medication, such as clotrimazole 500mg PV qweek or 200mg PV twice a week
Pregnant Patients
- Intravaginal clotrimazole or miconazole are the only recommended treatments
- Duration is 7 days
- PO fluconazole associated with congenital malformations and spontaneous abortions[2]
- ↑ Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.
- ↑ Molgaard-Nielsen D et al. Association Between Use of Oral Fluconazole During Pregnancy and Risk of Spontaneous Abortion and Stillbirth. JAMA. 2016;315(1):58-67.