Treatment of recurrent vvc

The goal of treating recurrent VVC is control of the infection, rather than cure. First, any acute episodes are treated, followed by maintenance therapy. For the treatment of acute episodes, intravaginal or oral azoles can be utilized. Although acute episodes of recurrent VVC will respond to azole therapy, some patients may require prolonged therapy in order to achieve remission. To achieve remission, a second dose of oral fluconazole 150 mg repeated 3 days after the first dose or 14 days of topical azole therapy can be used. The practitioner should consider that nonalbicans infections are more common in recurrent VVC; therefore, fluconazole and itraconazole resistance may make these agents less effective.

O After achieving remission, recurrent VVC requires long-term suppressive therapy for 6 months (Table 83—3). To improve adherence to long-term suppressive therapy, oral therapy, typically with fluconazole, is preferred. Fluconazole 150 mg weekly for 6 months will prevent recurrence of infection in 90% of women.15 Cessation of suppressive therapy is associated with resurgence of symptomatic infection in 50% of women.16

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