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
- Vaginal cream 10% (£7.48 = 5g)
- Pessaries 100mg (£3.85 = 6 pessaries)
- Pessary 500mg (£9.06 = 1 pessary)
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
- Patients should be advised that clotrimazole products may damage latex condoms and diaphragms
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
- Metronidazole vaginal gel is not licensed for use in children under 18 years.
- 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
- Safety and efficacy in paediatric patients have not been established
Balance Activ BV
(Lactic acid and glycogen)
- Vaginal pH correction gel (£5.25 = 7 x 5ml tubes)
Indications
Dose
- Insert contents of 1 tube once or twice weekly
Notes
- Balance Activ BV vaginal gel is included for use in difficult to treat bacterial vaginosis. It is also available to purchase from a community pharmacy.