Adult Outpatients: Urogenital Infections: Vaginitis

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Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines.  Some antimicrobials are restricted (ID-R).  Click on link for guidelines on obtaining authorization.

Diagnosis

Common Pathogens

Drug(s) of First Choice

Alternative Drug(s)

Comments

Candidal Vaginitis

Candida albicans

Fluconazole 150 mg PO x 1 dose

Miconazole 2% cream 5 g intravaginally x 3 days

OR

Miconazole 100 mg suppository, one suppository daily x 7 days

OR

Clotrimazole 1% cream 5 g intravaginally x 7-14 days

Single dose topical therapies are available but are less effective.

 

Seven day regimens are not superior to 3 day regimens.

Protazoan Vaginitis

Trichomonas vaginalis Metronidazole 2 g PO x 1 dose  Metronidazole 500 mg PO BID x 7 days 

In treatment failures to metronidazole, retreat with metronidazole 500 mg PO BID x 7 days. 

 

Bacterial Vaginitis

Gardnerella, other anaerobes

Metronidazole 500 mg BID PO x 7 days

OR

Metronidazole vaginal gel 0.75%, 5 g intravaginally daily x 5 days

OR

Clindamycin vaginal cream 2%, 5 g intravaginally daily x 7 days  

Clindamycin 300 mg PO BID X 7 days

OR

Clindamycin ovules 100 mg intravaginally daily x 3 days