Title:

Lecture updated: Candidal Vulvovaginitis - Treatment of Refractory cases added

Summary:

4. Persistent or recurrent vulvovaginal candidiasis (VVC) that is resistant to fluconazole:

Non-Fluconazole Antifungal Options

A. Topical Azoles (Longer Courses)

• Clotrimazole 2% cream intravaginally nightly for 7–14 days.
• Miconazole 2% cream intravaginally nightly for 7–14 days.
• Nystatin suppositories (100,000 IU) nightly for 14 days (especially for C. glabrata).

B. Oral Alternatives to Fluconazole

• Itraconazole 200 mg twice daily for 3–7 days (for C. albicans).
• Posaconazole 400 mg twice daily on day 1, then 400 mg daily for 3 days 
• Voriconazole (if C. krusei or highly resistant strains are present) 400 mg twice daily for 1 day followed by 200 mg twice daily for 13 days

C. Boric Acid (For Non-albicans or Resistant Strains)

• 600 mg boric acid in gelatin capsules intravaginally once daily for 14–21 days.
• Maintenance: Twice weekly for 3–6 months if recurrent.
• Caution: Avoid in pregnancy; may cause irritation.

D. Flucytosine (For C. glabrata)

• Intravaginal 17% flucytosine cream (compounded) + 3% amphotericin B cream nightly for 14 days.

E. Amphotericin B (Severe Refractory Cases)

Intravaginal 50 mg amphotericin B suppositories nightly for 14 days.

Article:

https://obgynegy.com/lectures/detail/95-infections-of-the-vagina/part-2