- Author: Jill M Krapf, MD, FACOG; Chief Editor: Christine Isaacs, MD more...
In considering treatment for vulvovaginal candidiasis, distinguishing between sporadic or recurrent episodes of the disease is of great importance. Most strains of C albicans, the usual cause of uncomplicated sporadic vulvovaginal candidiasis, are sensitive to azole-based antifungal agents and are therefore usually responsive to all forms of antifungal therapy.
Atrophic vaginitis is usually treated with topical vaginal estrogen for 1-2 weeks to alleviate symptoms. Treatment is then continued at decreased intervals for maintenance. An oral estrogen regimen can also be used.
Since no specific cure is available for vulvar vestibulitis, treatment should focus on the alleviation of symptoms.
Hydrocortisone (0.5-1%) and fluorinated corticosteroids in lotions or creams may help to reduce symptoms of contact dermatitis. These medications are usually most effective against true allergic reactions.
These agents are used to treat extreme vaginal pruritus. Cream is for symptomatic relief, especially in pediatric vulvovaginitis.
Because of its mineralocorticoid activity and glucocorticoid effects, this is the drug of choice in treating pruritus in vulvovaginitis. The primary therapeutic effects of topical corticosteroids result from their anti-inflammatory activity, which is nonspecific (ie, they act against most causes of inflammation, including mechanical, chemical, microbiologic, and immunologic). Do not use very high-strength or high-potency agents on the face, groin, or axilla.
These agents are used to treat vulvovaginal candidiasis. Topical azole antifungals achieve cure rates of 85-95%. Nystatin demonstrates a 75-80% cure rate. Oral fluconazole has a cure rate comparable to topical azole antifungals. It may be preferred by patients because of the ease of 1-time dosing.
Intravaginal and topical therapies with a variety of antifungals, such as clotrimazole, miconazole, terconazole, and tioconazole, are highly effective. Many of the preparations are now available OTC. 1-, 3-, and 7-day regimens can be used. Cure rates of 90% are reported with longer courses.
Butoconazole is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing fungal cell death.
This is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing fungal cell death.
Clotrimazole is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing fungal cell death.
Fluconazole is a synthetic oral antifungal (broad-spectrum bistriazole) that selectively inhibits fungal cytochrome P-450 and sterol C-14 alpha-demethylation. Consider the drug's ease of use, although the direct cost may be a limiting factor. Do not recommend oral antifungals in pregnancy.
Miconazole is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing fungal cell death.
Terconazole is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing fungal cell death.
Ketoconazole is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing fungal cell death.
Nystatin is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing fungal cell death.
These agents are used in the treatment of atrophic vaginitis in postmenopausal women. Oral estrogen replacement also is effective and has other health benefits.
Several topical steroid preparations are available, including equine estrogen, estradiol, and dienestrol. Estrogens are indicated for atrophic vaginitis and atrophic urethritis associated with menopause.
Estrogen Receptor Antagonists
These agents competitively bind to estrogen receptors, producing a nuclear complex that decreases deoxyribonucleic acid (DNA) synthesis and inhibits estrogen effects.
Tamoxifen may be used for women who are very concerned about estrogen exposure. It can act as either an estrogenic antagonist or agonist, depending on the target tissue.
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|Butoconazole||2% cream, 5 g intravaginally for 3 days|
|Butoconazole||2% cream, 5 g (butoconazole 1-sustained release), single intravaginal application|
|Clotrimazole||1% cream, 5 g intravaginally for 7–14 days|
|Clotrimazole||100 mg vaginal tablet for 7 days|
|Clotrimazole||100 mg vaginal tablet, 2 tablets for 3 days|
|Miconazole||2% cream 5 g intravaginally for 7 days|
|Miconazole||100 mg vaginal suppository, 1 suppository for 7 days|
|Miconazole||200 mg vaginal suppository, 1 suppository for 3 days|
|Miconazole||1200 mg vaginal suppository, 1 suppository for 1 day|
|Nystatin||100,000-unit vaginal tablet, 1 tablet for 14 days|
|Tioconazole||6.5% ointment 5 g intravaginally in a single application|
|Terconazole||0.4% cream 5 g intravaginally for 7 days|
|Terconazole||0.8% cream 5 g intravaginally for 3 days|
|Terconazole||80 mg vaginal suppository, 1 suppository for 3 days|
|Fluconazole||150 mg oral tablet, 1 tablet in single dose|