Version July 2025
Azole-resistant C. albicans infection is suspected when the patient's symptoms and physical examination findings are refractory despite appropriately dosed and used azole drugs (any azole). These patients undergo drug resistance testing with assessment of MIC of various antifungal drugs.
This management plan is based on the limited available data and our clinical experience.BV: bacterial vaginosis; MIC: minimum inhibitory concentration; VVC: vulvovaginal candidiasis.
* Discussion of testing options to confirm VVC and/or other causes of symptoms are presented in related UpToDate content on abnormal vaginal discharge.
¶ Treatment of persistent or recurrent C. albicans infection is discussed in related content in UpToDate text and algorithms.
Δ Patients with recurrent infection may need treatment for six months, or more. Some fluconazole resistant infections may be sensitive to ketoconazole or itraconazole. For more information on treatment of sporadic versus recurrent vulvovaginal candidiasis, refer to related discussion in UpToDate content.
◊ Boric acid is only to be used vaginally. Oral consumption of boric acid can result in death.