Candidiasis Treatment in Singapore: Candidiasis treatment clinic, Singapore. Private and confidential service. Definitions, references, and latest news.
Candidiasis Treatment is usually with:
Treatment is indicated for symptomatic patients. It is not recommended for asymptomatic patients with a positive Gram stain or culture because 10-20% of women harbour Candida species or other yeasts in the vagina in the absence of symptoms.
Vulval emollients and or topical antifungal/steroid creams may provide symptomatic relief for secondary associated vulval dermatitis. Avoid local irritants (e.g. perfumed products) and tight fitting clothing (IV, C).
Uncomplicated vulvovaginal candidiasis (VVC)
1. Clotrimazole vaginal pessary 200mg daily x 3 days or 500 mg single dose [II, A]
2. Miconazole nitrate vaginal pessary 200mg daily x 3 days [II, A]
3. Econazole nitrate pessary 150mg intravaginally nightly x 3 days [II, A]
4. Nystatin pessary 100,000 U daily x 7 to 14 days [II, A]
5. Butoconazole 2% cream 5g intravaginally x 1 day [II, A]
6. Fluconazole 150mg orally single dose [II, A]
1. Clotrimazole pessary 100mg or cream (1%) 5g intravaginally daily x 7 days [II, A]
2. Miconazole nitrate vaginal pessary 100mg or cream (2%) 5g intravaginally daily x 7 days [II, A]
3. Tioconazole ointment (6.5%) intravaginally 4.6g in a single application [II, A]
4. Miconazole 1,200mg vaginal pessary x 1 day [II, A]
Note: The topically applied azole drugs are more effective than nystatin.
Candidiasis in pregnancy
Only topical azole therapy should be given. Longer courses may be necessary. Oral azole therapy is contraindicated [II, B].
Candidiasis in HIV infection
Candidiasis tends to occur with a higher frequency and persistence in HIV-positive women and colonization rates correlate with the severity of immunosuppression. These patients should be treated with the same treatment regimens as for HIV-negative women.
Recurrent vulvovaginal candidiasis
This is defined as 4 or more episodes of symptomatic vulvovaginal candidiasis annually. Patients must be evaluated for any predisposing factors e.g. uncontrolled diabetes mellitus, immunosuppression, corticosteroid and long-term antibiotic use. Repeated courses of treatment may be required. Infection by less susceptible yeasts e.g. C glabrata may require a longer duration of therapy.
Systemic treatment may be indicated for resistant/recurrent candidiasis:
1. Itraconazole 100mg orally bid x 1-3 days [II, A]
2. Fluconazole 150mg orally single dose [II, A]
1. Fluconazole 100-200mg orally once a week x 6 months [II, B]
2. Clotrimazole pessary 500mg once a week x 6 months [II, B]
3. Itraconazole 400mg once a month x 6 months [II, B]
Caution: Anecdotal reports of oral contraceptive failure with prolonged oral azole therapy. The creams and suppositories are oil-based and may weaken latex condoms and diaphragms. Risk of idiosyncratic drug-induced hepatitis with itraconazole.