Other treatment options
Thrush due to Candida spp other than C albicans may be less responsive to topical imidazole or oral fluconazole. If symptoms persist with standard treatment in otherwise uncomplicated VVC, fungal culture should be considered. Non-azole treatments should be reserved for azole-resistant thrush and non-C albicans spp.24,30
Options include nystatin pessaries 100,000 units or boric acid 600mg or amphotericin B vaginal suppositories 50mg used daily for 14 days. Intravaginal flucytosine 5g cream or 1g pessary may be used with nystatin or amphotericin B.24
Other pharmacological approaches which may benefit VVC include antiallergy medicines. Cetirizine 10mg daily for six months may cause remission where fluconazole has been unable to completely suppress symptoms. Zafirlukast may be beneficial for thrush in women with a history of atopy.
General advice for good skin care with VVC symptoms is to avoid use of potential irritants such as perfumed soap or wipes. Emollients may be used on the vulva as a soap substitute, moisturiser and barrier cream, but not internally.
Possible steps that might help reduce recurrent thrush in some women include avoiding:24
· wearing incorrectly fitted clothing in unbreathable fabric;
· the use of daily pant liners; or
· vaginal douching.
If there is a pain during sexual activity, using a lubricant may help.