| Severe vaginitis symptoms |
| Oral fluconazole 150 mg every 72 hours for two or three doses (depending on severity). |
| OR |
| 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. |
| Recurrent vulvovaginal candidiasis |
| Induction with fluconazole 150 mg every 72 hours for three doses, followed by maintenance fluconazole 150 mg once per week for six months. |
| If fluconazole is not feasible, options include 10 to 14 days of a topical azole or alternate oral azole (eg, itraconazole) followed by topical maintenance therapy for six months (eg, clotrimazole 200 mg [eg, 10 g of 2%] vaginal cream twice weekly or 500 mg vaginal suppository once weekly). |
| Nonalbicans 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 |
| Pregnancy |
| Topical clotrimazole or miconazole for 7 days |
