Treatment of complicated vaginal candidiasis

Severe vaginitis symptoms

Oral fluconazole 150 mg every 72 hours for two or three doses (depending on severity).

Topical azole antifungal therapy daily for 7 to 14 days. A low potency topical corticosteroid can be applied to the vulva for 48 hours to relieve symptoms until the antifungal drug exerts its effect.

Non-albicans Candida vaginitis

Therapy depends upon species identified:

C. glabrata: Intravaginal boric acid* 600 mg daily for 14 days
- If failure occurs: 16% topical flucytosine cream, 5 g nightly for 14 days
C. krusei: Intravaginal clotrimazole, miconazole, or terconazole for 7 to 14 days
All other species: Conventional dose fluconazole (150 mg)

Compromised host (eg, poorly controlled diabetes, immunosuppression, debilitation) and Candida isolate susceptible to azoles

Oral or topical therapy for 7 to 14 days

Boric acid capsules and flucytosine cream are not commercially available, but can be made by a compounding pharmacy.

* Boric acid capsules can be fatal if swallowed.

Data from: Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:503.

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Treatment of complicated vaginal candidiasis