Treatment of Candida
Recommended regimen:
- Fluconazole* capsule 150mg as a single dose, orally.
Recommended topical regimen (if oral therapy contraindicated):- Clotrimazole pessary 500mg as a single dose, intravaginally
Oral therapies must be avoided in pregnancy
Severe Vulvovaginal Candidiasis
In patients with severe VVC
(i.e. extensive vulval erythema, oedema, excoriation, and fissure formation)
Recommended regimen:
- Fluconazole 150mg orally on day 1 and 4
Alternative regimens:
Clotrimazole 500mg pessary intravaginally on day 1 and 4
Miconazole vaginal capsule 1200mg on day 1 and 4
Recurrent VVC ( 4 episodes / year )
Recommended Regimen:
Induction: fluconazole 150mg orally every 72 hours x 3 doses *
Maintenance
fluconazole 150mg orally once a week for 6 months
Alternative Regimens
Induction : topical imidazole therapy can be increased to 7-14 days according to
symptomatic response
Maintenance for 6 months
o Clotrimazole pessary 500mg intravaginally once a week
o Itraconazole 50-100mg. Orally daily
- Oral therapies must be avoided in pregnancy, risk of pregnancy and breastfeeding.
Non-albicans Candida species and azole resistance
Recommended Regimen
- Nystatin pessaries 100,000units intravaginally at night for 12-14 consecutive nights
Alternative Regimens:
Boric acid vaginal suppositories 600mg daily for 14 days*
Amphotericin B vaginal suppositories 50mg once a day for 14 days
Flucytosine 5g cream or 1g pessary intravaginally with amphotericin or nystatin daily for 14 days.
Avoid in pregnancy
Recurrent VVC due to azole resistant Candida:
Nystatin pessaries 100,000units intravaginally at night for 14 nights per month for 6 months.
Consider 14 days per month for 6 month of the alternative regimens
Pregnancy & Breastfeeding
Recommended regimens (acute VVC in pregnancy):
- Clotrimazole pessary 500mg intravaginally at night for up to 7 consecutive nights*
Recommended regimen (recurrent VVC in pregnancy)
Induction– topical imidazole therapy can be increased to 10-14 days according to
symptomatic response
Maintenance: Clotrimazole pessary 500mg intravaginally weekly
Recommended regimens (acute and recurrent VVC in breastfeeding):
- Treatment regimens using topical imidazoles should be as per the
recommendations listed above for non-pregnant women with acute and recurrent
VVC.
FOLLOW-UP
- Follow-up and test of cure for patients with acute VVC is unnecessary if
symptoms resolve. - Patients with recurrent VVC should be advised to return if they experience
poor or partial response to - therapy>>>>repeat microscopy and culture is indicated to assess for
microbiological cure or new resistance - Patients who demonstrate microbiological response but not clinical
response to therapy should be reassessed for alternative causes of their
symptoms - On completion of suppressive therapy patients should be advised about the
management of future acute episodes (as per acute VVC) and when to
return for review (e.g. if frequency of recurrence >4 episodes per year or
acute symptoms do not settle with treatment).
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