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Candida - female genital - Management
How should I manage treatment failure in women who have poorly controlled diabetes or who are immunocompromised?
- Check that treatments have been used as recommended.
- Review the clinical evidence on which vulvovaginal candidiasis was diagnosed.
- Consider alternative diagnoses.
- Reassess for other predisposing risk factors, and remove or control as far as possible.
- Send a vaginal specimen for culture.
- Manage:
- Give general advice about avoiding local irritants (such as soaps and shower gels) and tight-fitting synthetic clothes.
- If compliance has been a problem with an intravaginal imidazole, prescribe a course (7 days) of an oral antifungal (e.g. fluconazole or itraconazole).
- If compliance has been a problem with oral antifungal, then prescribe a course (6–14 days) of intravaginal imidazoles (e.g. clotrimazole, econazole, or miconazole).
- For girls between 12 and 16 years old, offer a 7 day course of oral antifungal (fluconazole or itraconazole). However, an intravaginal antifungal may be considered if the girl is sexually active, if tampons are being used, or if there is no other alternative.
- Refer, or seek specialist advice, if:
- Treatment failure is unexplained.
- Treatment fails again.
- The woman develops systemic symptoms.
In depth
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