Treatment of uncomplicated vaginal candidiasis

Drug and trade name(s)	Requires a prescription in US	Preparation	Intravaginal* dose for adult
Clotrimazole
Gyne-Lotrimin^¶	No	1% cream	1 applicatorful (approximately 5 g) daily for seven days
Gyne-Lotrimin 3^¶	No	2% cream	1 applicatorful (approximately 5 g) daily for three days
Gyne-Lotrimin^Δ	Not applicable (not available in US)	100 mg vaginal tablet^Δ	Insert 1 vaginal tablet daily for seven days or 2 tablets daily for three days
Miconazole
Monistat 7^¶	No	2% cream (combination kit may include 2% miconazole cream for external use)	1 applicatorful (approximately 5 g) daily for seven days
Monistat 3^¶	No	4% cream	1 applicatorful (approximately 5 g) daily for three days
Monistat 7^¶	No	100 mg vaginal suppository	1 suppository daily for seven days
Monistat 3^¶, Vagistat-3	No (combination kit) Yes (generic suppository)	200 mg vaginal suppository (combination kit may include 2% miconazole cream for external use)	1 suppository daily for three days
Monistat 1	No	1200 mg vaginal suppository (combination kit may include 2% miconazole cream for external use)	1 suppository for one day
Nystatin^◊
Nystatin vaginal^Δ (former US trade name Mycostatin)	Not applicable (not available in US)	100,000 unit vaginal tablet	Insert 1 vaginal tablet daily for 14 days
Terconazole^¥
Terazole 7, Zazole^¶	Yes	0.4% cream	1 applicatorful (approximately 5 g) daily at bedtime for seven days
Terazole 3, Zazole^¶	Yes	0.8% cream	1 applicatorful (approximately 5 g) daily at bedtime for three days
Terazole 3, Zazole^¶	Yes	80 mg vaginal suppository	1 suppository daily at bedtime for three days
Tioconazole
Vagistat-1, 1-Day (from Monistat)^¶	No	6.5% ointment	1 applicatorful (approximately 5 g) at bedtime as a single dose
Butoconazole
Gynazole-1	Yes	2% cream	1 applicatorful (approximately 5 g) as a single dose
Fluconazole oral administration^§
Diflucan^¶	Yes	150 mg oral tablet	Single dose by mouth
Ibrexafungerp
Brexafemme	Yes	150 mg oral tablet	Two 150 mg tablets twice a day for one day (4 tablets total)

There are no significant differences in efficacy among topical and systemic azoles (cure rates >80% for uncomplicated vulvovaginal candidiasis).

US: United States.
* Except fluconazole and ibrexafungerp, which are given orally).
¶ Generic equivalent preparation(s) are available in US.
Δ Not available in US.
◊ Cure rate with nystatin is 70 to 80%.
§ Itraconazole is another oral antifungal that appears to be effective^[1].
¥ Rare cases of anaphylaxis and toxic epidermal necrolysis have been reported during terconazole therapy.

Reference:

Pitsouni E, Iavazzo C, Falagas ME. Itraconazole vs fluconazole for the treatment of uncomplicated acute vaginal and vulvovaginal candidiasis in nonpregnant women: a metaanalysis of randomized controlled trials. Am J Obstet Gynecol 2008; 198:153.

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