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Candida - female genital - Management
How should I manage treatment failure of severe vulvovaginal candidiasis?
- Consider alternative diagnoses — a wrong diagnosis is a common cause for treatment failure.
- Reassess for predisposing risk factors, and remove or control as far as possible.
- Send a vaginal specimen for culture.
- Manage:
- If non-compliance has been a problem with an intravaginal imidazole, prescribe a course of oral fluconazole 150 mg (2 doses 3 days apart).
- If non-compliance has been a problem with oral fluconazole, prescribe clotrimazole pessaries 500 mg (2 doses 3 days apart).
- For vulval symptoms, consider prescribing a topical imidazole cream in addition to an oral or intravaginal antifungal.
- For girls aged between 12 and 16 years, offer oral fluconazole.
- In this age group oral antifungals are generally preferred over intravaginal treatments. However, intravaginal antifungals may be considered if the girl is sexually active, if she uses tampons, or if there is no other alternative.
- Refer, or seek specialist advice, if:
- Symptoms have not improved and treatment failure is unexplained.
- Treatment fails again.
In depth
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