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
Fluconazole 200-400 mg
(3-6 mg/kg) daily (A-I)
Unable to tolerate Oral
Therapy
An echinocandin**; or AmB-d
0.3-0.7 mg/kg daily (B-II)
Fluconazole-Refractory
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.
Alternative
Micafungin 150 mg daily, caspofungin
50 mg daily, anidulafungin 200 mg daily
or AmB-d 0.3-0.7 mg/kg daily.
**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.
