Factors involved in patient choice of oral or vaginal treatment for vulvovaginal candidiasis

Figures & data

Table 1 Treatment options for acute vulvovaginal candidiasis

Drug	Formulation	Dose
Nystatin	100,000 U vaginal tablet	100,000 U/14 days
Butoconazole	2% sustained release cream	5 g/1 day
	2% cream	5 g/7 days
Clotrimazole	1% cream	5 g/7 days
	2% cream	5 g/3 days
	100 mg vaginal suppository	100 mg/7 days
	200 mg vaginal suppository	200 mg/3 days
	500 mg vaginal suppository	500 mg/1 day
Miconazole	2% cream	5 g/7 days
	100 mg vaginal suppository	100 mg/7 days
	200 mg vaginal suppository	200 mg/3 days
	1,200 mg vaginal suppository	1,200 mg/1 day
Terconazole	0.4% cream	5 g/7 days
	0.8% cream	5 g/3 days
	80 mg vaginal suppository	80 mg/3days
Tioconazole	2% cream	5 g/3 days
	6.5% cream	5 g/1 day
Oral
Fluconazole		150 mg single dose
Itraconzole		200 mg bid ×3 days
Ketoconazole		400 mg bid ×3 days

Abbreviation: bid, twice a day.

Table 2 Considerations in selecting azole treatment for VVC

	Topical	Oral	Comment
Pregnant	Recommended	Not recommended	Nystatin per vagina preferred by some
Speed of action	Slightly quicker	Slight delay	Minimal difference unless extensive vulvitis
Efficacy	Excellent	Excellent	No difference but for both duration depends on severity
OTC availability	Widely available	No	Oral therapy available without prescription in few countries
Convenience	Depends upon duration Less	Major advantage	Validated
Women’s preference in studies	Rare	Overwhelming	Multiple studies validate
Local side effects	Infrequent	–
Systemic adverse effects	–	Infrequent
Cost	Depends upon country and insurance
Selection of non-albicans Candida	Unknown	Speculated possible	Inconclusive data
Contribution to azole resistance	Unknown	With long-term use	Inconclusive data
Recurrent VVC (maintenance)	Inconvenient	Convenient	Convenience and proven efficacy

Abbreviations: OTC, over-the-counter; VVC, vulvovaginal candidiasis.