Template:Candidiasis Treatment: Difference between revisions
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''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 uncomplicated|population=Adult}} (preferred)<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> | ||
**A second dose at 72hrs may be given if patient is still symptomatic | **A second dose at 72hrs may be given if patient is still symptomatic | ||
*Intravaginal therapy | *Intravaginal therapy | ||
** | **{{AntibioticDose|disease=Candida vulvovaginitis|drug=Clotrimazole|dose=1% cream vaginally x7d OR 2% vaginally x3d|context=Intravaginal uncomplicated|population=Adult}} | ||
**{{AntibioticDose|disease=Candida vulvovaginitis|drug=Miconazole|dose=2% cream vaginally x7d OR 4% cream x3d|context=Intravaginal uncomplicated|population=Adult}} | |||
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**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 | ||
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<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|population=Adult}} | ||
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Revision as of 01:16, 20 March 2026
Uncomplicated
There is little resistance to azole medications; treatment often dictated by patient preference.
- Fluconazole 150mg PO once (preferred)[1]
- A second dose at 72hrs may be given if patient is still symptomatic
- Intravaginal therapy
- Clotrimazole 1% cream vaginally x7d OR 2% vaginally x3d
- Miconazole 2% cream vaginally x7d OR 4% cream x3d
- 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.