Recurrent vulvovaginal candidiasis is defined as 4 or more symptomatic episodes in a 12-month period. It may occur in as many as 8% of women of reproductive age. Because there is still no consensus on managing this condition, the following broad principles relating to a 2-stage management plan are recommended.

 

Induce symptom remission with continuous antifungal treatment. Recommended regimes:

1. A vaginal imidazole (eg clotrimazole 1%) or nystatin intravaginally, at night          OR           

2. Fluconazole 50 mg orally, once daily (PBS  for pregnancy  and breastfeeding)          OR         

3. Itraconazole capsules 100 mg orally, once daily (PBS  for pregnancy  and breastfeeding)

 

The time to achieve remission of symptoms varies from 2 weeks to 6 months. Maintain remission with interval therapy; the treatment interval varies from weekly to once a month (eg premenstrually) depending on response.

 

A suitable weekly regimen is: 

1. Fluconazole 150 to 300 mg orally, weekly    (PBS  for pregnancy  and breastfeeding)       OR         

2. Itraconazole capsules 100 to 200 mg orally, weekly   (PBS  for pregnancy  and breastfeeding)      OR

3. Clotrimazole 500 mg pessary intravaginally, weekly   (PBS  for pregnancy  and breastfeeding)    OR         

4. Nystatin 100 000 units/5 g vaginal cream 1 applicatorful intravaginally, weekly.  (PBS  for pregnancy  and breastfeeding)

 

If oral antibiotics are required for inter-current infection, you may need to return to continuous antifungal therapy after the course is completed, to treat an antibiotic-induced flare of their condition. There is generally no need to stop a low-dose oral contraceptive pill   

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