John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Medications used to treat yeast infections generally fall into two main categories.
Azole medications are a family of antifungal drugs that end in the suffix "-azole." They block the manufacture of ergosterol, a crucial material of the yeast cell wall. Without ergosterol, the yeast cell wall becomes leaky and the yeast die. Fortunately, ergosterol is not a component of human membranes, and azoles do not harm human cells.
Polyene antifungal medications include nystatin and amphotericin B. Nystatin is used for thrush and superficial candidal infections. Doctors reserve amphotericin B for more serious systemic fungal infections. The antifungals work by attaching to the yeast cell wall building material, ergosterol. These medications then form artificial holes in the yeast wall that cause the yeast to leak and die.
Nystatin (Nilstat, Mycostatin) is commonly prescribed for oral thrush. The oral liquid is administered with a dropper to adequately coat the inside of the mouth in infants and young children. Troches (lozenges) may be prescribed for older children and adults with oral thrush.
Clotrimazole (Mycelex) troches are also available for treating oral thrush in older children and adults.
Fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral) are prescription products administered as tablets or oral liquid. They may be used when topical agents are ineffective, large areas of skin is affected, or for individuals at a higher risk of fungal infection, such as patients with cancer or HIV.
The U.S. Food and Drug Administration approved fluconazole for vaginal candida infections.
These oral antifungal drugs interact with many medications. Your doctor and pharmacist should be aware of all medications that you are taking, including nonprescription drugs and herbal products.
The most common side effects include nausea, vomiting, and abdominal pain.
The doctor will periodically draw blood samples to monitor for the rare toxicity of liver impairment for those patients on long-term medications.
Vaginal creams and suppositories include butoconazole (Femstat), clotrimazole (Femizole-7, Gyne-Lotrimin), miconazole (Monistat Vaginal products), terconazole (Terazol), and tioconazole (Vagistat).
Follow the manufacturer's instructions for one to seven days depending on the formulation. If the irritation increases, immediately discontinue the medication. Some products contain topical antifungal cream to use on irritated external genital areas along with vaginal cream or suppositories.
Pregnant women should consult a doctor before using these treatments.
If symptoms continue for more than one week despite treatment, consult a doctor. These symptoms may be caused by something other than a fungal infection.
People who have abdominal pain, fever, or offensive-smelling vaginal discharge should consult their physician before using these products.
Chronic mucocutaneous candidiasis (CMC) refers to a heterogeneous group of disorders characterized by recurrent or persistent superficial infections of the skin, mucous membranes, and nails with Candida organisms, usually Candida albicans.