Candida vulvovaginitis
Topical agents (see table below) or fluconazole (Diflucan) 150 mg single dose for uncomplicated vaginitis (A-I)
Recurrent vulvovaginal candidiasis (VVC) is managed with fluconazole (Diflucan) 150 mg weekly for 6 months, following initial control of the recurrent episode Intravaginal Agents Gynazole-1 (butoconazole) 2% cream 5 g intravaginally x 1 or 3 days Gynazole-1 (butoconazole) 2% cream 5 g (butoconazole-sustained release) single intravaginal application Clotrimazole 1% cream 5 g intravaginally for 7-14 days Gyne-Lotrimin 7 (clotrimazole) 100 mg vaginal tablet for 7 days Gyne-Lotrimin 3 (clotrimazole) 200 mg vaginal tablet for 3 days Monistat (miconazole) 2% cream 5 g intravaginally for 7 days Miconazole 100 mg vaginal suppository, one suppository for 7 days Monistat 3 (miconazole) 200 mg vaginal suppository daily x 3 days Monistat 1 (miconazole) 1,200 mg vaginal suppository for 1 day Nystatin 100,000-unit vaginal tablet, one tablet for 14 days Vagistat-1 (tioconazole) 6.5% ointment 5 g intravaginally x 1 Terazol 7 (terconazole) 0.4% cream 5 g intravaginally for 7 days Terazol 3 (terconazole) 0.8% cream 5 g intravaginally for 3 days Terconazole 80 mg vaginal suppository, one suppository for 3 days
Neonatal Candidiasis
AmB-d 1 mg/kg daily (A-II) or fluconazole 12 mg/kg daily (B-II) for 3 wks
LFAmB 3-5 mg/kg daily (B-III)
A lumbar puncture and dilated retinal examination should be performed on all neonates with suspected invasive candidiasis. Intravascular catheter removal is strongly recommended. Duration of therapy is at least 3 wks. LFAmB used only if there is no renal involvement. Echinocandins should be used with caution and only when other agents cannot be used.
Esophageal Candidiasis Primary
Primary Treatment
Unable to tolerate Oral Therapy
Fluconazole-Refractory
Fluconazole 200-400 mg (3-6 mg/kg) daily (A-I)
An echinocandin**; or AmB-d 0.3-0.7 mg/kg daily (B-II)
Itraconazole oral solution 200 mg daily; or posaconazole suspension 400 mg bid; or voriconazole 200 mg IV or PO
bid (A-III) x 14-21 d.
**Echinocandin dosing in adults is anidulafungin, 200 mg loading then 100 mg/d, caspofungin, 70 mg loading then 50 mg/d, and micafungin, 100 mg/d.
Micafungin 150 mg daily, caspofungin 50 mg daily, anidulafungin 200 mg daily or AmB-d 0.3-0.7 mg/kg daily.
Alternative
