Treatment of nonalbicans infections

Treatment response rates are lower for nonalbicans infections. Although an optimal regimen is unknown, use of intravaginal azole therapy for 7 to 14 days is recommended. Terconazole may prove more effective than other azoles in the treatment of nonalbicans infections since C. glabrata and C. tropicalis are more susceptible to terconazole. 17 For second-line therapy, boric acid 600 mg in a gelatin capsule administered vaginally twice daily for 2 weeks followed by once daily during menstruation is effective.18 Local irritation often limits the use of boric acid. Topical 4% flucytosine is also effective but use should be limited due to the potential for resistance.

Table 83-3 Treatment Options for Maintenance Therapy Daily

Boric acid 600 mg in gelatin capsule vaginally daily during menses (5 days) Itraconazole 100 mg orally once daily Ketoconazole 100 mg orally once daily Weekly

Clotrimazole 500 mg vaginal suppository once weekly Fluconazole 100 or 150 mg orally once weekly Terconazole 0.8% cream 5 g vaginally once weekly Monthly

Fluconazole 150 mg orally once monthly Itraconazole 400 mg orally once monthly

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