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Balanitis - Management
Basis for recommendation
These recommendations are based on expert advice from review articles [Edwards, 1996; English et al, 1997] and the UK national guideline on the management of balanoposthitis from the British Association for Sexual Health and HIV [BASHH, 2008].
Non-specific dermatitis, with or without candidal colonization
Contact dermatitis or marked inflammation
Candidal balanitis
- Topical imidazoles and oral fluconazole are widely recommended by experts based on their proven effectiveness in the treatment of candidiasis of the skin, toenails, and perineum in infants [Hay and Moore, 2004].
- CKS recommends continuing treatment until symptoms settle based on advice given in the UK national guideline on the management of balanoposthitis from the British Association for Sexual Health and HIV. Although the licences for most antifungal drugs recommend continuing treatment for a short period of time after clinical cure, CKS found no evidence to support this approach in balanitis.
- CKS found no evidence that one antifungal is more effective than any other in the treatment of balanitis. However, in one study oral fluconazole was preferred to topical treatment by approximately 80% of men requiring treatment for candidal balanitis [Stary et al, 1996].
- CKS found no evidence for the use of topical terbinafine for candidal infection of the skin and it is not recommended for use in children [ABPI Medicines Compendium, 2006]. Systemic treatment with terbinafine is not appropriate for refractory candidiasis and it is not licensed for this purpose [BNF 56, 2008].
Gardnerella-associated or streptococcal balanitis
- An appropriate antibiotic should result in rapid resolution of symptoms and eradication of the offending organism. CKS found no specific trial evidence for the use of antibiotics for balanitis, but antibiotics are routinely used by experts when balanitis is thought to be caused by a bacterial infection.
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