7.2.2. Vaginal and vulval infections

Fungal

Primary Care antimicrobial guidelines recommend a single dose of fluconazole 150mg orally for candidiasis. A single dose of clotrimazole (5g vaginal cream or 500mg pessary) is second-line therapy.

The 100mg clotrimazole pessaries are included for use in pregnancy.

Clotrimazole
  • Intravaginal cream 10% (£8.21 = 5g)
  • Pessaries 100mg (£3.50 = 6)
  • Pessary 500mg (£3.39 = 1)

Indications

Dose

  • Cream: apply to anogenital area 2-3 times daily
  • Intravaginal cream: insert 5 g at night as a single dose; can be repeated once if necessary
  • Pessary: insert 1 pessary at night as a single dose; can be repeated once if necessary

Notes

  1. Patients should be advised that clotrimazole products may damage latex condoms and diaphragms
Miconazole
  • 2% vaginal cream (£4.33 = 78g)

Indications

Dose

  • One 5g applicatorful once daily for 10-14 days, or twice daily for seven days. Course may be repeated once.
Nystatin
  • Pessaries 100,000 units (unlicensed preparation)
Flucytosine and Nystatin
  • Flucytosine 1g with nystatin 100,000 units in 8g vaginal gel (unlicensed preparation)

Bacterial

Metronidazole
  • Vaginal gel 0.75% (£4.31 = 40g)

Indications and dose

  • Bacterial vaginosis
    • One applicatorful (5g) inserted into the vagina once daily at bedtime for 5 consecutive nights.

Notes

  1. Metronidazole vaginal gel is not licensed for use in children under 18 years.
  2. Please refer to the Antimicrobial Guidelines for Primary care for further information on oral or vaginal treatment
Clindamycin
  • Vaginal cream 2% (£10.86 = 40g)

Indications and dose

  • Bacterial vaginosis
    • One applicatorful (5g) inserted into the vagina once daily at bedtime for 7 consecutive nights
    • In patients for whom a shorter treatment course is desirable, a 3 day regimen has been shown to be effective

Notes

  1. Safety and efficacy in paediatric patients have not been established
Balance Activ® BV

(Lactic acid and glycogen)

  • Vaginal Gel 5ml tube (£5.25 = 7)

Indications

  • Bacterial vaginosis

Dose

  • Insert contents of 1 tube once or twice weekly

Notes

  1. Balance Activ vaginal gel is included for use in difficult to treat bacterial vaginosis. It is also available to purchase from a community pharmacy.

 

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