7.    Treatments available without prescription for thrush are the azoles, fluconazole and clotrimazole. Azoles are synthetic antimycotic agents that act by inhibiting replication of yeast cells through interfering with the synthesis of ergosterol, the main sterol in the yeast cell membrane.

Fluconazole is presented as a single-dose 150€‰mg oral capsule. It is well absorbed when taken by mouth, and symptoms usually improve within12 to24 hours following administration. Adverse effects are generally mild and mainly gastrointestinal, including abdominal pain, diarrhoea, nausea and vomiting and flatulence. Fluconazole interacts with a number of drugs, including those metabolised by cytochrome P450 isoenzymes CYP3A4 and CYP2C9, but interactions are unlikely to be clinically significant with a single dose of fluconazole. Nevertheless, caution should be exercised with patients taking drugs that have both a narrow therapeutic window and also act on vital organ systems such as the heart and brain, or are involved with glucose metabolism.

Clotrimazole is only used topically because of adverse effects when given orally and varying absorption rates, and because it is metabolised in the liver to inactive compounds. It is available for intravaginal use as a single 500€‰mg pessary, a 5€‰g prefilled single application of 10% cream, and as 2% cream available for twice or three times daily application to the external genitalia. Symptoms usually begin to improve more quickly than with oral fluconazole. The bases used in preparations may damage latex condoms and diaphragms. Night-time use is recommended for intravaginal preparations as the patient will be lying down for several hours, allowing the drug a chance to act and avoiding the problems of seepage