#383 A single dose for treating yeast infections: Is it really this simple?
CLINICAL QUESTION
Does route or duration of antifungals matter when treating uncomplicated vulvovaginal candidiasis in non-pregnant women?
BOTTOM LINE
Route and duration do not impact efficacy; only a single dose of oral fluconazole or intravaginal antifungal (example clotrimazole) is needed. Patient preference should guide treatment choice.
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EVIDENCE
- Data from systematic review of randomized, controlled trials (RCTs) and individual RCTs.1-5 Meta-analysis performed by PEER to provide useable information.
- Route: Single oral (150mg fluconazole) versus single intravaginal or multidose intravaginal (various antifungals and dosing), 8 RCTs, 1002 patients.1 At 1-8 weeks post-treatment:
- Clinical cure (no symptoms): ~80% all groups, no statistical difference.
- Adverse effects: No difference total adverse effects; more systemic side effects (gastrointestinal, headaches) with oral; more local side effects with intravaginal (vaginal burning, irritation).
- Duration: 4 RCTs, 349 patients, single intravaginal versus multidose intravaginal (various antifungals ). 2-5 At 1-4 weeks post-treatment:
- Clinical cure (no symptoms): ~85%, no statistical difference.
- Adverse effects: ~3% vaginal burning in both groups.
- Limitations: Often not blinded, unclear randomization concealment, possible selective reporting, and industry funding often not disclosed. Limited evidence on clinically relevant outcomes including patient preference. Did not evaluate multidose oral treatment as standard practice is single dose oral.
CONTEXT
- Single dose fluconazole (150mg oral tablet) and single dose clotrimazole (500mg intravaginal tablet taken from a tablet/combination pack or 10% internal cream) are available over-the-counter. Fluconazole also available by prescription for drug-plan coverage.
- Inadequate evidence to determine whether adding lactic acid to clotrimazole improves efficacy. Currently only clotrimazole 500mg tablets include lactic acid.
- Adding external clotrimazole cream for vulva involvement: Relieved more itching (76% versus 55%) and extravaginal redness (72% versus 52%) than placebo external cream at 6-8 days.6
- Women should be advised that while it may take several days for symptoms to resolve, only a single dose of antifungal treatment is needed.
- For unresolving vaginitis symptoms, a repeat vaginal swab is recommended to confirm the diagnosis prior to further treatment.7
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Does route or duration of antifungals matter when treating uncomplicated vulvovaginal candidiasis in non-pregnant women?
Complete Activity
Good information on a common problem.
I always suspected this but now have the evidence. I usually give the patient the optio between oral and intravaginal
Will try swab more often
very useful summary
suggestion to repeat swab is SOO important,
I always prefer topical first if not better I try oral, but will re-swab in future
great short review
great summary