What is the best oral treatment for yeast vaginitis?
Oral treatment of yeast can use nystatin, amphotericin B or fluconazole(Diflucan®), although fluconazole is used most frequently for yeast vaginitis. Treating yeast vaginitis by oral medicine, however is not the first choice, recommended treatment.
Topical vaginal treatment with butaconazole (Femstat® Nystatin ®) is the first choice treatment rather than oral fluconazole (Diflucan®) because it is non-prescription and very effective. Fluconazole is effective but non candida albicans species are becoming more resistant to it an requiring higher doses to eradicate the yeast (4, 5).
Even C. albicans species may become more and more resistant to fluconazole as it is exposed more and more to the drug in clinical use (6). The scientific feeling is to save the systemic (oral) therapy for patients who have blood-borne yeast infections such as with AIDs or chemotherapy for cancer rather than inducing resistant organisms while treating only vaginal infections.
There can be resistances of the yeast species to commonly prescribed medications. One of the major causes of these resistances is due to the emergence of C. glabrata as the infectious agent rather than C. Albicans. C. glabrata is more resistance to many of the treatments (7).
What are other vaginitis treatments
Oral tablets with lactobacilli acidophillus that recolonize the gastrointestinal tract, and milk and yogurt with L. acidophilus can be effective in reducing the recurrence of bacterial vaginosis and yeast vaginitis although they are not very effective for primary treatment (8, 9). Vaginal tablets or suppositories containing lactobacillus can also recolonize the vagina and help prevent recurrence.
There are no other oral therapies that I am aware of for bacterial or yeast vaginitis. As far as other topical treatments for yeast infections, boric acid vaginal suppositories at 600 mg/day for 10 days is 80% effective for C. glabrata which has been resistant to other standard therapies (10). Essential oil therapy can also be used to treat yeast vaginitis. Tea tree oil has been shown to be effective against yeast in concentrations of 0.5% to 2% (11).
Does antibiotic treatment make you more likely to get a vaginitis?
Certain antibiotics seem to cause more yeast infections or overgrowth than others. Cephalosporins such as Keflex® permit more yeast overgrowth (12).
Cipro® (ciprofloxacin), Augmentin® (amoxicillin/clavulanate potassium), and any other penicillin derivitives such as amoxicillin or ampicillin seem to destroy the normal vaginal lactobacillus and predispose to more yeast infections than do other antibiotics.
Tetracycline, sulfa, metronidazole and even erythromycin do not cause yeast infections as often.
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