10718722, 1:30 AM BASHH vulvovaginal candidiasis guideline | Independent professional body guideline | Guidelines National guideline for the management of vulvovaginal candidiasis By British Association for Sexual Health and HIV | 9 October 2020 Overview This guideline offers recommendations on the diagnostic tests, } treatment regimens, and health promotion principles for the effective management of acute and recurrent vulvovaginal candidiasis (VVC). This Guidelines summary only covers key recommendations for primary care. For a complete set of recommendations, see the full guideline. Vulvovaginal candidiasis diagnostic and management pathway v Clinical features v Diagnosis v Management v Acute VVC + Recommended regimen © fluconazole(Al capsule 150 mg as a single dose, orally + Recommended topical regimen (if oral therapy contraindicated): hips. guidelines co ukiwomens-healhvbashh-vulvovaginal-candidasis-quidaline!455 164 article 1s10118122, 1:30 AM BASHH vulvovaginal cancdia's guideline | Independent professional body guideline | Guidelines © clotrimazole pessary 500 mg as a single dose, intravaginally(®] + Alternative regimens: © clotrimazole vaginal cream (10%) 5 g as a single dose, intravaginallyl®] © clotrimazole pessary 200 mg intravaginally at night for 3 consecutive nights(®] © econazole pessary 150 mg intravaginally as a single dose or 150 mg intravaginally at night for 3 consecutive nights[8) © fenticonazole capsule intravaginally as a single dose 600 mg or 200 mg intravaginally at night for 3 consecutive nights{6] © itraconazole 200 mg orally twice daily for 1 day POIAI © miconazole capsule 1200 mg intravaginally as a single dose, or 400 mg intravaginally at night for 3 consecutive nights(6] © miconazole vaginal cream (2%) 5 g intravaginally at night for 7 consecutive nights.(8] Severe vulvovaginal can + Recommended regimen: © fluconazole 150 mg orally on day 1 and 4 * Alternative regimens: © clotrimazole 500 mg pessary intravaginally on day 1 and 4 © miconazole vaginal capsule 1200 mg on day 1 and 4 + Low-potency corticosteroid creams are also thought by some experts to accelerate symptomatic relief in conjunction with adequate antifungal therapy. Recurrent VVC + Recommended regimen: © induction: fluconazole 150 mg orally every 72 hours x 3 dosesiA] © maintenance: fluconazole 150 mg orally once a week for 6 months{A] + Alternative regimens: htps:www.guidelines.co ukiwomens-healthvbashh-vlvovaginal-candidasis-quidaline!455 164 article 2610718722, 1:30 AM BASHH vulvovaginalcancidiasis guideline | Independent professional body gudline | Guidelines © induction: topical imidazole therapy can be increased to 7-14 days according to symptomatic response © maintenance for 6 months: = clotrimazole pessary 500 mg intravaginally once a week = itraconazole 50-100 mg orally daily.Al For information on non-albicans Candida species and azole resistance, see the full guideline. Pregnancy and breastfeeding + Recommended regimens (acute WC in pregnancy): © clotrimazole pessary 500 mg intravaginally at night for up to 7 consecutive nights] * Alternative regimens (acute WC in pregnancy): © clotrimazole vaginal cream (10%) 5 g intravaginally at night for up to 7 consecutive nights{C] © clotrimazole pessary 200 mg intravaginally at night for up to 7 consecutive nights © econazole pessary 150 mq intravaginally at night for up to 7 consecutive nights © miconazole capsule 1200 mg(‘l or 400 mg intravaginally at night for up to 7 consecutive nights © miconazole vaginal cream (2%) 5 g intravaginally at night for 7 consecutive nights + Recommended regimen (recurrent VVC in pregnancy) © induction: topical imidazole therapy can be increased to 10-14 days according to symptomatic response © maintenance: clotrimazole pessary 500 mg intravaginally weekly + Recommended regimens (acute and recurrent WC in breastfeeding): © treatment regimens using topical imidazoles should be as per the recommendations listed above for non-pregnant women with acute and recurrent VVC. Alternative or supplementary treatments hips. guidelines co ukiwomens-healhvbashh-vulvovaginal-candidasis-quidaline!455 164 article a810118122, 1:30 AM BASHH vulvovaginal cancdia's guideline | Independent professional body guideline | Guidelines * Some evidence of benefit: © anti-allergy: = cetirizine 10 mg orally daily for 6 months may cause remission in women who fail to get complete resolution of symptoms with suppressive fluconazole = zafirlukast 20 mg orally twice daily for 6 months may be considered as maintenance prophylaxis for recurrent VVC, particularly in women with a history of atopy (afirlukast production was discontinued in the UK in 2018, commercial reasons are cited for this decision and it is stressed that there were no safety concerns; the closest available alternative is montelukast but this has not been studied in the setting of VVC) ‘= Insufficient or no evidence of benefit: © probiotics: there continues to be insufficient evidence to support the use of oral or vaginal probiotics (mainly Lactobacill) for the treatment or prevention of VVC: = an increasing number of studies suggest that their adjunctive use may improve clinical outcomes or reduce the likelihood of recurrence; however, the quality of evidence is variable and inconsistent in terms of the probiotic or regimen used = the mode of action might be via modulation of inflammatory processes rather than competition with Candida © tea tree and other essential oils: are antifungal in vitro but they may cause hypersensitivity reactions. There is insufficient evidence to recommend use in recurrent VVC © breathable underwear with antimicrobial protection: there is insufficient evidence to recommend their use in recurrent VVC. Small studies have shown a reduction in itching, burning, erythema and recurrences compared with cotton briefs in women with recurrent WC ona standard fluconazole suppressive regimen © yoghurt and honey mixes: there is insufficient evidence to support the use of vaginal applications of yoghurt and honey mixes, although there have been some reports of benefit, with symptom improvement © diet: there is no evidence to support any dietary modifications, including reducing carbohydrate or yeast intake © oral garlic: there is no evidence of benefit from oral garlic on Candida colonisation Observational studies have shown that garlic taken orally may cause heartburn, nausea, htps:www.guidelines.co ukiwomens-healthvbashh-vlvovaginal-candidasis-quidaline!455 164 article 4610118122, 1:30 AM BASHH vulvovaginal cancdia's guideline | Independent professional body guideline | Guidelines diarrhoea, flatulence, bloating, and an offensive body odour. For more information on treatment of VVC for women with diabetes mellitus, HIV infection, hormones and contraception information, reactions to treatment, and follow-up, see the full guideline. Footnotes v Full guideline: British Association for Sexual Health and HIV (BASHH). British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis (2019). BASH, 2019. Available at: www.bashhguidelines.org/media/1223/we-2019.pdf First included: June 2012. Last updated: August 2019. Credit: Lead image: Syda Productions/stockadobe.com Downloads ‘Summary of the vulvovaginal candidiasis diagnostic and management pathway PDF, Size 0.11 mb hips. guidelines co ukiwomens-healhvbashh-vulvovaginal-candidasis-quidaline!455 164 article 55