Template:Candidiasis Treatment: Difference between revisions
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==== | ====Uncomplicated==== | ||
*Fluconazole 150mg PO once | ''There is little resistance to azole medications; treatment often dictated by patient preference.'' | ||
*[[Fluconazole]] 150mg PO once (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 | |||
**[[Clotrimazole]] 1 % cream applied vaginally for 7 days OR | |||
**[[Clotrimazole]] 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==== | ||
* | <u>Severe or immunosuppressed</u> | ||
* | *[[Fluconazole]] 150mg PO q72h x 3 doses | ||
* | |||
* | <u>Non-albicans species</u> | ||
* | *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. | |||
<u>Recurrent (≥ 4 infections in a year)</u> | |||
*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==== | ====Pregnant Patients==== | ||
*Intravaginal | *Intravaginal [[clotrimazole]] or [[miconazole]] are the only recommended treatments | ||
*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 22:38, 19 June 2024
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 applied vaginally for 7 days OR
- Clotrimazole 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.