ORAL FLUCONAZOLE
Place in Therapy
There are a variety of oral and vaginal preparations available to patients over-the-counter for treatment of uncomplicated vulvovaginal candidiasis. There is a robust body of evidence to suggest that oral and topical formulations achieve comparable clinical cure rates, which are in excess of 90%.1,2 Considering this evidence, whether to treat with oral or topical formulations is largely based on patient preference including cost, route of administration and convenience. Any contraindications to therapy should remain major considerations in the decision to dispense an anti-fungal agent for oral or topical use.
Oral and topical formulations differ slightly in their side effect profiles, which may help direct therapy per patient preference. Oral formulations are more likely to cause gastrointestinal intolerance, head and rash whereas topical formulations may cause local burning or irritation. Despite these side effect differences, studies have suggested that patient consistently reported a preference for the convenience of oral formulations.2
References:
1. Pappas PG, Kauffman CA, Andes D et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(5):503.
2. Watson MC, Grimshaw JM, Bond CM, Mollison J, Ludbrook A. Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush). Cochrane Database Syst Rev. 2001