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Treatment regimen for chronic thrush in women. Thrush treatment - effective schemes

Despite the success of modern medicine in the development of drugs, diagnosis and identification of risk factors for candidal infection, the problem of treating vulvovaginal candidiasis (thrush) in women is still relevant.

Over the past 20 years, the number of candida carriers, women with low-symptom, chronic recurrent "thrush", women infected with Candida non-albicans has been growing, drug therapy in these groups is the most difficult, requires care and high qualifications of the attending physician.

The fungi of the genus Candida themselves can develop resistance to drugs and react poorly to the measures taken, including due to the formation of persistent biofilms on the surface of the vaginal epithelium.

We will devote this material to the features of acute and chronic recurrent vulvovaginal candidiasis (thrush) in women.

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    1. Briefly about pathology

    Vulvovaginal candidiasis (VVC, VVC) is caused by fungi of the genus Candida. Most often they belong to the species.

    Vulvar and vaginal candidiasis is usually accompanied by the following symptoms:

    1. 1 White, curdled, or creamy discharge from the genital tract.
    2. 2 Itching and burning in the vagina, vulvar area. These symptoms can worsen after hygiene procedures, the use of intimate hygiene products, during intercourse.
    3. 3 Violation of urination - soreness, frequent urge.
    4. 4 Soreness during intercourse - dyspareunia.
    5. 5 Edema and hyperemia of the vaginal mucosa, less often the vulva.

    Preference is given to azoles (fluconazole, clotrimazole, miconazole), which in this case are more effective than nystatin. This approach allows to relieve symptoms in 80-90% of patients who completed the course correctly (treatment regimens for uncomplicated thrush in Table 1).

    Table 1 - Treatment regimens for vaginal candidiasis (thrush) in non-pregnant women according to CDC guidelines, 2015

    If the symptoms of candidiasis persist after a course of therapy or a relapse develops over the next 2 months, then the patient is sampled for inoculation on a nutrient medium in order to clarify the dominant species of candida and determine their sensitivity to known antimycotics.

    The mechanism of development and pathogenesis of recurrent vulvovaginal candidiasis is not fully understood. Many patients do not have obvious predisposing factors that could lead to chronic infection.

    In chronic thrush, Candida non-albicans is more often detected (in about 10-20% of cases), which are insensitive to basic drugs.

    With relapse C. albicans therapy includes several courses of antimycotic drugs:

    1. 1 Initial course - a short course using topical or systemic azoles. For a better clinical effect, some doctors suggest prolonging the use of local azoles to 7-14 days or prescribing fluconazole orally, orally according to the scheme - 1, 4, 7 days of therapy at a dosage of 100, 150 or 200 mg, respectively.
    2. 2 Supportive course. Fluconazole is taken at a dose of 100-150 mg once a week for 6 months. If this is not possible, then local azoles are prescribed in intermittent courses. This therapy is effective, but 30-50% of women relapse after drug withdrawal.

    For Candida non-albicans, the optimal regimen has not been established. It is proposed to use local or systemic drugs from the azole group (except for fluconazole) for 1-2 weeks. In case of relapse, boric acid (600 mg vaginal gelatin capsules) can be used for 14 days once a day. This scheme leads to recovery in 70% of cases.

    In pregnant women, you can use azoles in the form of vaginal suppositories or vaginal cream. Taking medications by mouth is unacceptable.

    4. DGGG, AGII and DDG Program (2015)

    According to this provision, the situation when a woman with a normal immune status in a smear detects fungi of the genus Candida, but there are no symptoms, does not require treatment (exception, pregnant women).

    Acute vaginal candidiasis, according to these recommendations, is treated with the following drugs:

    1. 1 Local therapy with nystatin drugs for at least 6 days.
    2. 2 Local therapy with drugs based on clotrimazole, econazole, miconazole, etc.
    3. 3 Systemic therapy (fluconazole, oral itraconazole).
    4. 4 Cyclopiroxolamine vaginal cream, vaginal suppositories, course for at least 6 days.

    All of the above options have approximately the same effectiveness in acute vaginal candidiasis. The cure rates (clinical and laboratory) are up to 85% in a week after the end of the course and 75% in 1-1.5 months.

    In pregnant women, the use of imidazoles is more effective than polyenes (comparison was made with nystatin). In case of asymptomatic carriage 6 weeks before the expected date of birth, prophylactic treatment is recommended. Its purpose is to prevent infection of the newborn.

    For chronic thrush, a two-stage treatment is offered:

    1. 1 Initial course (relief of symptoms, normalization of laboratory parameters).
    2. 2 Supportive therapy - local (clotrimazole) or systemic (fluconazole).

    The European Guidelines for the Management of Women with Abnormal Vaginal Discharge - IUSTI / WHO (2011) J Sherrard, G Donders et al. Include treatment regimens for vulvovaginal candidiasis, trichomoniasis and bacterial vaginosis.

    Treatment regimens for thrush in non-pregnant women recommended by IUSTI / WHO are presented in Table 2 below.

    Table 2 - Schemes for the use of antimycotics in non-pregnant women recommended by IUSTI / WHO (2011) for the treatment of acute vaginal candidiasis

    For thrush with severe itching, hydrocortisone ointments and gels can be used. For patients receiving oral antimycotics (fluconazole, itraconazole), moisturizers (emollients) can be used.

    Treatment for chronic thrush includes:

    1. 1 Elimination of predisposing factors, correction of concomitant diseases.
    2. 2 Initial course - 10-14 days.
    3. 3 Supportive therapy involves the appointment of antifungal drugs 1 time / week, a course of 6 months.
    4. 4 Avoiding soaps and moisturizing creams (emollients) can help cope with dry vulvar skin.
    1. 1 Inclusion of the basic therapy for thrush of another drug from the group of polyenes - natamycin (Pimafucin).
    2. 2 The use of natamycin for chronic recurrent thrush and infection with C. non-albicans.

    Table 3 - Treatment regimens for acute and chronic thrush in non-pregnant women according to the Federal Clinical Guidelines. Click on the table to view

    7. Adjunctive therapy

    Auxiliary therapy for thrush allows you to eliminate concomitant infections of the reproductive system, normalize the vaginal microbiota, and improve the general condition of the woman's body.

    1. 1 Correction of nutrition for thrush, exclusion of foods that promote the growth and reproduction of fungi. Undesirable foods include sugar and sweet foods, yeast pastries. Diet therapy for thrush in more detail.
    2. 2 Vaginal candidiasis is often combined with intestinal dysbiosis. This confirms the need for an integrated approach in the treatment of vaginal candidiasis. The scheme can be supplemented by taking natural probiotics - fermented milk products containing lactobacilli and bifidobacteria.
    3. 3 Thrush against the background of pronounced vaginal dysbiosis, gardnerellosis requires the appointment of complex drugs, for example, neo-penotran, polygynax, terginan. Their effect is to eliminate inflammation, influence on anaerobes, gardnerella and fungi.
    4. 4 We cannot recommend drugs for the restoration of vaginal microflora (gynoflor, vaginorm, ecofemin) until a sufficient number of studies on their effectiveness have been performed.
    5. 5 It is important to eliminate foci of chronic infection in the body, if any. In the presence of diabetes mellitus, dynamic observation and therapy by an endocrinologist are required.
    6. 6 We cannot recommend immunomodulators, dietary supplements, homeopathy due to lack of evidence base. In our opinion, a healthy lifestyle, balanced nutrition, physical activity fully replace these groups of drugs.
    7. 7 Traditional medicine, herbal treatments are distracting and have a placebo effect. They should not be used on women.

    8. The problem of candida resistance to antimycotics

    The problem of resistance of fungi of the genus Candida to antimycotic agents is no less urgent than the resistance of bacteria to antibiotics. More often than others, resistance to drugs of the azole group develops, of particular importance is low sensitivity to azoles of C. non-albicans. The explanation lies in the mechanism of action of drugs in this group.

    By inhibiting the enzymes associated with cytochrome P 450, the drug disrupts the synthesis of ergosterol, a component of the fungal cell membrane. This is how the fungistatic effect develops.

    Stability is acquired in several ways. C. albicans is characterized by the accumulation of the ERG11 gene mutation, which is associated with the coding of the ergosterol synthesis enzyme. It ceases to bind to azoles, but forms bonds with the natural substrate lanosterol. The latter is converted into ergosterol during the reaction.

    Another mechanism is associated with the elimination of the drug from the cell using ATP-dependent carriers.
    Resistance to azoles is cross, that is, it develops to drugs of the entire group. In this case, the use of polyenes is possible.

    9. Evaluation of the effectiveness of treatment

    The criteria for the effectiveness of treatment are the following indicators:

    1. 1 Complete recovery, the vagina was sanitized: there are no clinical symptoms, signs of inflammation, laboratory tests (culture on a culture medium) confirm the absence of fungus.
    2. 2 Improvement: decrease in the severity of symptoms of the disease, objective signs.
    3. 3 Relapse - the appearance of new symptoms of thrush, detection of the fungus by smear microscopy 2-4 weeks after the course of therapy.

    In the acute form, control is prescribed 14 days after the last dose of medication.

    10. Prevention of relapse

    To prevent recurrence of vaginal candidiasis, factors that create favorable conditions for the growth and reproduction of Candida fungi should be excluded.

    1. 1 Mycoses develop in a warm and humid environment. This is facilitated by wearing tight clothing made of synthetic, poorly breathable fabrics. It is better to choose cotton, comfortable underwear. Linen should be changed daily.
    2. 2 Panty liners trap moisture and heat and create an environment that encourages fungus growth. Their frequent change allows you to eliminate these disadvantages.
    3. 3 It is necessary to maintain a balance in the use of different groups of foods, give preference to vegetables, fruits, cereals, dairy products, lean meat. Limit sweet and starchy foods to a minimum.
    4. 4 You cannot use antibiotics without a doctor's prescription, you cannot extend the course for a longer period than the doctor recommended. Antibacterial drugs can be combined with fluconazole (150 mg) in women with a history of vulvovaginal candidiasis.
    5. 5 Glucocorticoids with long-term use also promote the growth of fungal flora. You cannot use them without a doctor's prescription.
    6. 6 Antifungal drugs should not be used without a doctor's recommendation, as is the case with antibiotics, this leads to the development of resistance in the fungi of the genus Candida.
    7. 7 CDC does not recommend sex partner treatment for thrush in women.
    8. 8 It is recommended to visit a gynecologist at least once a year in the absence of complaints, as needed, in the presence of any symptoms from the reproductive and urinary systems.

    The information presented in the article is intended for acquaintance with modern trends in medicine and cannot replace an in-person consultation with a specialist. It cannot be used for self-medication!

Thrush (candidiasis, genital fungus) is an inflammatory disease of an infectious origin, which manifests itself in the form of vulvovaginitis, sometimes it is involved in the process and the urinary system (cystitis, urethritis). The disease is caused by pathogenic yeast-like fungi Candida, mainly albicans. In the structure of inflammatory diseases of the vagina, candidiasis is 30-45%. The main group of women suffering from it is of reproductive age.

Pathology has a tendency to chronic course, causing significant inconvenience both in the daily and in the intimate life of a woman. The abundance of drugs against vulvovaginal candidiasis on the pharmacological market does not eliminate the difficulties in therapy. They are associated with the characteristics of the course of the disease: a tendency to frequent recurrence, the development of drug resistance, the presence of many predisposing factors.

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    Clinical features

    Candida fungi are present in small amounts on the vaginal mucosa in healthy women, but do not cause them to develop thrush. Only under the influence of predisposing factors does the clinical manifestation of the disease occur. These conditions include immunosuppression (suppression of immunity) and impaired microbiocenosis:

    • taking medications (antibiotics, cytostatics, glucocorticoids, estrogen-progestational drugs);
    • concomitant pathology (HIV, infections, diabetes mellitus);
    • vaginal dysbiosis (presence of nonspecific vaginitis, STIs, bacterial vaginosis);
    • physiological immunosuppression during pregnancy.

    The acute form of thrush is diagnosed when a case is first detected or when it occurs sporadic (less than four times a year). It is manifested by itching, a burning sensation in the vagina, aggravated after water procedures; redness of the external genital organs, discomfort during urination and during intercourse.

    Chronic candidiasis is characterized by a prolonged course with remissions and relapses - more often than four cases of manifestation in 12 months.

    A complicated and uncomplicated type of flow is also distinguished. The second option has the following features: the first case or less often four times a year, the causative agent is Candida albicans, moderate manifestations, women with risk factors (prostitution, change of sexual partner, non-use of condoms, STIs).

    Treatment of candidiasis depending on the clinic

    The course of genital fungus is acute and chronic, depending on the frequency of occurrence.

    Acute form

    For an uncomplicated course, in most cases, local therapy will be sufficient - vaginal.

    Possible oral administration of drugs:

    • 150 mg of fluconazole (Diflucan, Flucostat) once, clinical manifestations will disappear within the first three days after taking the tablet;
    • 200 mg of intraconazole twice a day for three days.

    The control of the treatment result is carried out after seven days (smear on the flora).

    Chronic form

    A complicated course requires active tactics. It consists in a more prolonged local, systemic treatment, in the use of combined drugs, in a complex form of therapy (medicines inside and topically), in the correction of local immunity.

    It will be optimal to correct the provoking factors before starting treatment: the abolition of estrogen-progestogen drugs, glucocorticoids, antibiotics, correction of carbohydrate metabolism.

    Taking fluconazole is longer than in the acute course: 150 mg (one tablet) on the first day, the second after three days, the third after the same interval. Intraconazole: 200 mg morning and evening for a week.

    With regard to local treatment, when using Sertazol and Zalain, one candle is laid at night, re-application - after seven days. Rumisol, Neo-Penotran, Ginokaps forte are applied in the morning and in the evening, one candle at a time from one to two weeks. These are combined preparations containing, in addition to antimycotics (miconazole), an antibacterial substance (metronidazole). In some cases, they are a salvation for women with recurrent thrush on the background of vaginal dysbiosis.

    Lomexin is a new generation drug that has maximum activity compared to other antimycotics. The first capsule - vaginally at night, the second - after three days. After 10 days, the course can be repeated. There is another form of this remedy in the form of a 2% cream - daily inside the vagina with the applicator attached to the package, 7-10 days once a day. This remedy is indicated for ineffectiveness and resistance to the main antifungal medicines, in addition, it also has an antibacterial effect (staphylococci, streptococci). Candida can exist both separately and form biofilm substances, against the latter, many antimycotics are ineffective - this explains the chronization of the process. The anti-relapse effect of Lomexin is built on the latter: it is capable of destroying both biofilm and planktonic cells of Candida albicans.

    Lomexin, vaginal capsule

    In case of severe complicated, often occurring candidiasis, the following treatment regimen for thrush can be used: a combination of systemic therapy with local therapy. While taking fluconazole, intraconazole, put suppositories Rumisol, Neo-Penotran, Ginokaps forte, Sertazol, Zalain.

    Evaluation of the effectiveness of treatment is performed within three menstrual cycles immediately after the end of menstruation. With a tendency to recurrent episodes of thrush, it is necessary to carry out the therapy options indicated above, and the appointment of supportive local treatment for six months - a course once a month.

    Phytotherapy

    Plant-derived substances increase the duration of remission in recurrent thrush, they can replace supportive treatment. It is advisable to use them after the main course of antimycotics.

    Gynokomfort is a regenerating gel, the active components of which are tea tree oil extract, chamomile extract, panthenol, lactic acid, bisabolol. It is inserted vaginally with the applicator 1 to 2 times a day. Recommended for the normalization of microflora after infectious and inflammatory diseases of the vagina, after and during systemic antibiotic treatment.

    Malavit - concentrate, cream-gel. It contains lactic acid, copper ions, gum, cedar resin, mummy. Monotherapy is presented in three stages:

    1. 1. Treatment of genitals with Malavit solution 1:10 (5 ml of water or 10 ml per 100 ml).
    2. 2. Douching 1:10.
    3. 3. A loose gauze tampon is introduced into the vagina, abundantly moistened with a solution or cream-gel, and left for 2-5 hours. The course of application is 10 procedures.

    Vitaon is an oil extract of medicinal plants (mint, chamomile, wormwood, St. John's wort, rose hips, thyme, celandine, yarrow, calendula, caraway seeds, fennel, pine bud, mint essential oil, orange, fennel, camphor). It has anti-inflammatory, regenerating, immunomodulating, bactericidal action. Reception: soak tampons with Vitaon and lay.

    Immunomodulators

    The complex method of treatment of chronic recurrent thrush has positive reviews, which consists in the use, along with the main treatment of candidiasis or after it, means that activate the body's defenses. This may be necessary because a prolonged course of thrush is most often associated with a decrease in immune processes in the body and in the vagina specifically.

    Polyoxidonium 12 mg has an antioxidant effect, immunomodulator, detoxifier. Its use can improve the effectiveness of treatment, lengthen the period of remission. The drug is available in suppositories that can be placed rectally and vaginally. there are 10 suppositories in the package: the first three are injected one at a time every 24 hours for three days in a row, then every other day. This course of treatment can be repeated every 3-4 months to prevent the recurrence of thrush.


    Genferon in the form of suppositories, which can be administered vaginally, rectally. Dosage for 250,000 and 500,000 IU - twice a day, 1,000,000 IU - once a day; with a total duration of 10 days. Simultaneously with fungicides to take: in the morning 500,000 vaginally, at night 1,000,000 in the rectum. The drug is used in pregnant women from the 13th week of gestation at a dose of 250,000 IU twice a day vaginally / rectally for 10 days.

    Therapy during pregnancy

    The period of pregnancy is in itself a provoking factor for thrush due to the development of physiological immunosuppression. During the 1st and 2nd trimester, many fungicidal preparations are prohibited, as they can harm the fetus. Still, there are medications that can be used during this period:

    • Natacin, Pimafucin (based on natamycin) - three suppositories per pack, one a day for three days in a row.
    • Betadine, Ruvidone (povidone-iodine) - 14 suppositories, one twice a day for seven days.

    Starting from the 25th week, the list of medications is expanding: it can be Sertazol, Rumisol, Ginokaps - all topical drugs, since it is better to refuse systemic antimycotics during pregnancy.

    Joint therapy

    Optimal joint treatment is with the woman's sexual partner. Very often, the cause of recurrence of thrush is a man who is not cured of candida, who, after another sexual contact, sows pathogens into the woman's vagina. This is possible even in the absence of clinical manifestations in him, because there is also an asymptomatic carriage.

    Systemic therapy and local in the form of a cream are used. It can be fluconazole (the scheme is the same as for the patient) or Lomexin cream (2%) - daily on the scalp and foreskin of the penis once a day for 5-10 days.

Candidiasis or thrush is a disease that is caused by Candida fungi, has severe symptoms, and can occur in an acute or chronic phase.

Since pathology often appears in the weaker sex, you need to know the methods of treatment for them.

The treatment regimen for candidiasis in women is different and is selected for each woman personally. To determine the methods of therapy, you need to know several features of candidiasis.

General data on pathology

For successful treatment of vaginal candidiasis in women, it is necessary to know the features of the pathology. The main reasons for the development of the disease are as follows:

  1. Infection and a weak immune system.
  2. Chronic diseases of an infectious nature that relate to the reproductive organs and the genitourinary system.
  3. Diseases of the genital organs.
  4. Chronic pathologies in the body.
  5. Hormonal and endocrine disruptions. In this case, it could be diabetes, obesity, or pregnancy.
  6. Dysbacteriosis.
  7. Long-term treatment with medications, especially antibiotics or hormonal agents.

If candidiasis becomes chronic, then with the wrong methods of treatment, an exacerbation of symptoms is possible.

Also, relapse appears with improper use of medications or self-therapy.

The main symptoms of candidiasis in women are as follows:

  1. The appearance of a white discharge, similar to curd bloom.
  2. Hyperemia of the mucous membrane.
  3. The appearance of burning and itching, especially during intercourse or urination.
  4. Pain and cramps.

If the condition becomes more complicated, then a continuous plaque appears on the mucous membrane, which cannot be removed, in addition, there may be slight bleeding.

If the treatment regimen for candidiasis in women is determined correctly, and it is strictly adhered to, then there are no problems, and recovery occurs rather quickly.

The basic rules are as follows:

  1. Do not refuse to see a doctor or take swabs.
  2. Do not use medicines and other means on your own, without the permission of the doctor.
  3. If the main symptoms pass, do not stop treatment.
  4. Refuse traditional medicine, which cannot provide the proper result for candidiasis.

When choosing medicines, you do not need to use analogues and try to save money on treatment. Cheap counterparts cannot have a positive effect.

If there are financial difficulties, you need to explain the situation to the doctor so that he can choose the treatment in accordance with the money, while it will be effective.

Basic therapy program

It should be understood that Candida mushrooms cannot be completely eliminated, since such yeast bacteria are an integral part of a healthy flora.

In candidiasis, they begin to activate and grow rapidly, but in healthy people their number is minimal and cannot affect the state of health. When treating candidiasis, drugs can stop bacteria from multiplying and reduce the number of organisms already developed.

Comprehensive treatment of candidiasis is mandatory, which includes the following stages:

  1. The sensitivity of mushrooms to medicines is determined, which can be used for treatment.
  2. The acidity and composition of the mucous flora is normalized.
  3. Other disorders of the immune system are eliminated, minor pathologies are treated, which can be an impetus for reducing the protective functions of the body.
  4. The causes that cause the progression of candidiasis in women are removed or reduced. For this, treatment with medicines and hormonal agents is adjusted, the diet is normalized, and bad habits are abandoned.
  5. Medicines are prescribed to eliminate inflammation and other infectious diseases that can be transmitted through sexual intercourse.

If the treatment regimen for candidiasis in women is not followed, then a positive trend is excluded. Even with a favorable course of the disease, there are risks of relapse due to certain provocateurs.

Normalization of immunity

Any medications to eliminate candidiasis should be used after the immune system has normalized. The impact is carried out on general and local immunity.

If you do not strengthen, then the result of further treatment will be short-lived. A woman must definitely follow these rules:

  1. Apply topical probiotics to help stabilize the mucosal flora.
  2. The restoration of the intestinal flora is carried out, and measures are also used to eliminate dysbiosis. To do this, it is enough to enrich the body with vitamins, change the diet a little. The menu should contain a lot of protein, more foods with fiber and dietary fiber, and reduce the intake of carbohydrates.
  3. To normalize the acidity of the skin and mucous membranes, soaps or cosmetics recommended by doctors are used.
  4. Doctors prescribe immunomodulators and stimulants.

When the immune system is in good shape and proper protection of the body appears, vaginal candidiasis is treated.

In this case, the results of positive dynamics increase, recovery is faster.

Medicines for candidiasis in women

Based on the method of using drugs, they are divided into different types:

  1. Local preparations that are applied directly to the affected area. For treatment, ointments, creams or suppositories are used.
  2. Systemic medicines that must be taken orally. They are sold as pills or capsules, but intravenous injections are indicated for women in severe cases.

The main drugs of local action for candidiasis are divided according to the type of their action. Among them are:

  1. Medicines for the fungus or antimycotic drugs. Depending on the woman's condition and severity, clotrimazole-based medicines - Canesten or Antifungol, iconazole - Gino-travogen or miconazole - Miconazole, Ginesol, Klion-D can be prescribed.
  2. Antimicrobial drugs. These medicines are antibiotics, the active substance of which can be Natamycin, Nystatin or Levorin.
  3. Combined drugs. They include the first 2 groups of drugs, due to which a quick effect on the removal of candidiasis is achieved.

All local medicines can be used for the skin or mucous membranes. They are often sold as ointments or gels, and solutions can be used.

Pills are also used, which must be injected into the genitals. A feature of such treatment of candidiasis is the need to use the medicine 2-3 times a day, and they should be used systematically for about 2 weeks.

The main advantages of local drugs are:

  1. The appearance of a quick action from the treatment, as well as the relief of the main symptoms of the disease, which cause discomfort to the woman.
  2. Medicines almost do not enter the bloodstream, due to which they can be used during pregnancy, but it is necessary to use ointments and creams strictly on the recommendation of a doctor.
  3. Minimal influence of active substances on other internal organs and systems.

Among the disadvantages of local medications for candidiasis are:

  1. Positive and quick results appear if the pathology is not complicated and passes in a mild form, while candidiasis should be detected as early as possible.
  2. You will need to use several courses of treatment for a lasting result.
  3. There is a need to change the lifestyle, the main requirement is the refusal of sexual intercourse for the period of therapy.
  4. The likelihood of drug residue on the laundry.

Systemic medications for thrush are used orally. They also have a different mechanism of influence and distinguish 2 main groups:

  1. Antibiotics that inhibit fungal growth. For therapy, you need to buy Levorin, Nystatin or Natamycin tablets, which are taken orally.
  2. Antifungal agents. For treatment, drugs with the active substance Fluconazole are often used; Diflucan, Mikosist or Medoflucan are distinguished among the main medicines. You need to take the pills once. If the active substance is ketoconazole or itraconazole, then the treatment regimen must be determined by the doctor

During pregnancy, candidiasis appears quite often as a result of hormonal changes and a decrease in protective properties.

For this reason, favorable conditions for the growth of fungi appear. As a rule, during gestation, women will have strong discharge and obvious itching of the genitals. Throughout the entire period of pregnancy, there may be frequent relapses.

In such a situation, the treatment regimen should not be selected according to standards, since many drugs are prohibited, they have a toxic effect and can harm the woman and the fetus.

Some of the active substances can pass through the placenta, which leads to miscarriage or birth defects. Also, you can not use pills and other means without the permission of the doctor.

The treatment regimen should include some changes in the woman's life, her diet. It is imperative to follow the preventive rules:

  1. Create favorable and comfortable conditions at home, exclude possible hypothermia of the body. Keep your feet warm at all times.
  2. With candidiasis in pregnant women, certain drugs of local action are allowed. Suppositories and vaginal rinsing solutions based on natural ingredients are best suited. It is best to use chamomile or calendula products. Any folk and drug medicines should be used after consulting a doctor.
  3. To quickly restore and improve the results of therapy, natural hygiene products are used, without the presence of additives, dyes and harmful substances. Otherwise, mushroom growth may increase.
  4. In the diet, you need to add more foods with vitamins, lactobacilli, and fiber. For a pregnant woman with candidiasis and without pathology, it is useful to consume fermented milk products, which has a positive effect on the immune system.

Antibiotic treatment is possible if women have serious infectious diseases during pregnancy.

Often, the pathology is treated after the birth of children, although often this will not have to be done, since the fungi and candidiasis go away on their own.

During the treatment of any form of candidiasis, it will be necessary to adjust the diet and use auxiliary methods for treatment. The main ones will be recommended by the doctor, based on the woman's condition.

Evaluation of the effectiveness of therapy

To assess the effectiveness of the treatment of candidiasis in women, doctors use the following values:

  1. Complete recovery of the patient. The main symptoms of the disease, inflammatory processes, and all analyzes show the absence of pathogenic flora.
  2. The intensity of the main signs improves or decreases.
  3. Relapse - may appear approximately 2-4 weeks after the therapy.

In acute candidiasis, re-diagnosis is carried out a couple of weeks after the last medication intake.

As a rule, candidiasis does not become chronic for a long time and women themselves are more likely to be the culprits.

It is forbidden to independently determine the disease only by discharge and itching in the perineal region. The visual picture can be deceiving, as the signs are common to many other diseases.

In some situations, candidiasis in women does not appear at all until a certain time. The main mistake in treatment is the use of prescriptions from alternative medicine without the permission of a doctor.

Many recipes are beneficial and affect the local immune system, can clear up inflammation, as well as other symptoms of the disease, but do not have a therapeutic effect and cannot kill fungi.

If the disease becomes chronic, then the treatment cannot be carried out for several days.

In this state, a woman will have to be treated for about six months, but the first weeks are used active substances, after which the patient is transferred to supportive treatment.

Thrush in women - treatment quickly and effectively - how? This question worries many women who are faced with the unpleasant manifestations of this disease. Most often, without understanding the causes and mechanism of the pathology, women buy drugs at the pharmacy or use traditional medicine methods and try to get rid of the disease on their own. However, it can have a different course, and often persistent treatment is required for a long time with specially selected means.

So what is thrush and how to treat it correctly?

Causes and clinical manifestations of the disease

Why do women begin to develop thrush, and what are the reasons for the manifestation of unpleasant symptoms that require specific treatment? And is it possible to get rid of the disease on your own without going to the doctor? Indeed, often women, not fully understanding what candidiasis is, buy drugs at the pharmacy, based only on the advice of pharmacists or friends. Such self-activity, unfortunately, most often leads to the transition of pathology to a chronic or recurrent form, since the symptoms of thrush in a woman continue to develop, and drug treatment does not bring any results.

In the body of any person, fungi of the genus Candida are always present, belonging to conditionally pathogenic microorganisms. In this microflora, the causes of the onset and manifestation of thrush lie, in which treatment by a specialist is required. Usually Candida are in the body, not showing their presence in any way and without causing disturbance to the woman. But with a decrease in the body's defenses, the immune system loses control over the vital processes of the fungus, and it begins to actively multiply. This is how thrush develops, and its treatment requires preliminary special laboratory tests.

Excessive nervous or physical exertion, hypothermia or overheating can provoke increased mycelium growth. The transferred colds or infectious diseases will also lead to the development of thrush. And taking antibiotics or hormonal drugs creates favorable conditions for the life and reproduction of the fungus. Due to hormonal imbalance, the likelihood of the development of pathology is high and in diabetes, obesity, as well as during pregnancy. Increase the likelihood of developing thrush and addictions: smoking tobacco, drinking alcohol. An unbalanced daily diet, consisting mainly of fatty and fried foods, and a deficiency of vitamins, which is also the cause of the development of pathology.

Important. In order for the treatment of candidiasis in women to be effective, it is necessary to understand the causes and mechanism of the development of pathology.

The disease has its own characteristic manifestations. What does thrush look like in women? Most often, patients seek help when a white curdled plaque appears in the vagina and on the vulva, accompanied by discomfort and itching. But there are other signs that indicate the development of thrush in a woman, which requires treatment with medications. These symptoms include:

  • pain in the vagina when passing urine, as well as during intercourse;
  • itching sensations in the genital area;
  • a burning sensation in the vulva and vagina.

In the absence of timely treatment, over time, liquid or curdled discharge appears, leaving a white coating on the mucous membranes and having an unpleasant odor.

General principles of treatment

It is possible only with strict observance of all the advice of the attending physician. The complex of therapeutic measures includes not only taking medications, but also a diagnostic examination. Such an analysis will allow you to accurately answer the question of how to cure thrush quickly without the development of complications and side effects.

General rules for the treatment of candidiasis include the following points:

  • taking a smear for analysis. It is possible to determine exactly what and how it is more effective to treat thrush in a particular woman only after a bacteriological study. The laboratory will not only determine the type of candida that caused the disease, but also test the resistance of the pathogen to drugs. This will allow the doctor to choose the most radical remedies for thrush to treat a woman;
  • with thrush in women, her sexual partner is also treated in parallel, regardless of whether he has manifestations of pathology or not. This measure will allow to avoid further re-infection of the patient. Therapy is selected individually for men and women and may differ. In order to quickly and effectively get rid of thrush, you should not independently treat a man with the remedy prescribed by the doctor, even if these are the most effective drugs from her point of view;
  • medications should be taken at regular intervals. This approach will completely suppress the fungal mycelium;
  • medicines for thrush should be taken for as many days as prescribed by the attending physician, even if all manifestations of the disease have completely disappeared. Self-withdrawal of the drug ahead of time can lead not only to an exacerbation of candidiasis, but also its transition to more severe and intractable forms.

The form of the disease has a great influence on the methods of treatment and the choice of drugs. Candidiasis in women can be of three types: primary, recurrent and chronic. And before you cure thrush in a woman, you need to decide on the course of the disease.

Primary thrush is diagnosed in cases where a woman has never had a single episode of the disease in her anamnesis. Almost all women who started specific therapy on time under the supervision of a doctor quickly and reliably recovered from thrush. In the absence of proper treatment, the pathology becomes chronic or recurrent.

For reference. If a woman has thrush, both partners should undergo a bacteriological examination before being treated.

With a recurrent form of the disease, exacerbations occur from 4 to 12 times during the year. As a rule, such a pathology develops with untimely or inadequate treatment of the primary disease.

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The chronic course of candidiasis is manifested by erased symptoms that do not attract the woman's attention.

Local therapy

If candidiasis in women manifests itself for the first time, then it is enough to undergo a course of therapy with topical drugs. Typically, a full course of treatment for thrush takes ten days to two weeks. An important condition for the complete cure of pathology is the timeliness and continuity of drug administration. At the same time, the drugs used make it possible to treat thrush not only quickly and reliably, but also inexpensively.

Also, local treatment of thrush is included in complex therapy for recurrent and chronic forms of the disease. With candidiasis of the primary form in women, local treatment is carried out with vaginal tablets, suppositories, creams or gels, as well as solutions.

What topical preparations can cure thrush in women? The following remedies are most often successfully applied:

  • ointments Pimafucin, Candide, Zalain, Clotrimazole. Inserted into the vagina with a tampon 1 to 4 times a day for two weeks;
  • suppositories with Ketoconazole, Sertaconazole, Fluconazole, Livarol, Nystatin are introduced into the vagina 2 to 4 times a day for 10 to 15 days;
  • solutions of Miramistin, Kanesten, Chlorhexidine, sodium tetraborate and others will help to quickly cure thrush in girls. Preparations produced in liquid dosage form are used for douching, as well as for holding the toilet of the external genital organs;
  • vaginal tablets will also help to quickly cure thrush: Flucostat, Mikosist, Clotrimazole, Terzhinan.

The introduction of intravaginal agents should be carried out only after thorough hygienic treatment of the perineal area. The drugs are injected into the vagina while lying on your back. Also, after the procedure, you should remain in a horizontal position for about half an hour. This will allow the drug to penetrate all folds in the vagina and uterine pharynx.

For reference. Treatment with local preparations of thrush in women will be highly effective only if equal time intervals are observed between procedures for introducing drugs into the vagina.

General treatment

How to properly treat neglected thrush? With a chronic or recurrent course, the disease can also affect other internal organs. At the same time, fungal cells acquire resistance to fungicidal and fungistatic drugs. Therefore, before treating neglected thrush in women, the doctor will definitely conduct a bacteriological examination of the smear to determine the resistance of the pathogen to various groups of drugs. Before treating chronic or recurrent thrush in women, the drugs are applied in a bacterial laboratory to a colony of a fungus sown in a patient. For therapeutic purposes, drugs of those groups are used, the active ingredients of which have shown the greatest aggression towards the pathogen.

If thrush is diagnosed in an advanced form, the treatment will be quick and effective only under the condition of complex exposure, in which local remedies are supplemented with oral preparations of systemic action. This approach to therapy will not only locally suppress the colonies of the fungus, but also destroy its spores throughout the body, restore the normal acid-base balance of the mucous membranes and dermis, balance the amount of beneficial microflora, and normalize the immune system.

How to treat candidiasis in women with systemic drugs? Currently, oral tablets of the following groups are used for these purposes:

  • containing fluconazole. This active ingredient is contained in such agents as Fluconazole, Diflazon, Diflucan, Mikosist. In the treatment of vaginal candidiasis, drugs are used containing 150 mg of active ingredient in one tablet. The medicine is taken once. The therapeutic effect begins to be felt a few hours after taking the drug;
  • based on intraconazole. This line is represented by such drugs as Rumikoz, Irunin, Orungal, Intraconazole. The dosage of the medicine is selected by the doctor individually, depending on the severity of the pathology. The course of treatment for thrush in women lasts from one week to one and a half months;
  • including ketoconazole as the main active ingredient. Ketoconazole, Nizoral, Dermazole are most often chosen from this group. Funds are taken 1 - 2 tablets once a day. The duration of therapy is from 5 to 7 days.

Correctly selected drugs of specific systemic therapy will allow you to treat thrush quickly and effectively, without bringing the pathology to the transition to chronic forms. Self-medication of such a seemingly simple disease can lead to increased resistance of fungi to agents with fungicidal and fungistatic properties, which will complicate radical treatment and lead to serious complications.

Immune drug therapy

For women, treating thrush is often an intractable problem. Despite following all the doctor's recommendations and taking medications, it can be quite difficult to get rid of the disease. Most often, such situations arise when neglecting agents that do not have a direct effect on the pathogen.

How to quickly and effectively cure thrush with nonspecific drugs? To achieve high efficiency of therapy for any pathology, first of all, the cause that led to the development of the disease should be eliminated. The trigger mechanism in a sharp increase in the population of fungal microflora in the body is a malfunction of the protective forces. Therefore, to eliminate the cause of thrush in women, treatment is supplemented with a group of drugs that have a stimulating and modulating effect on the immune system. This approach to treatment will mobilize the body's own forces to fight the fungus in all organs and systems, which will significantly speed up the healing process and prevent the development of complications.

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Today there are a large number of medicines for the treatment of thrush. Therefore, it is not surprising that, having entered the pharmacy, it is difficult to choose the necessary medicine. For those who want to better understand this abundance and carefully choose the appropriate drug, the following information will be useful.

The main question is - in which cases is it better to take pills, and in which to use creams and suppositories? After all, in some way these methods of application differ?

Medicines for the treatment of thrush, depending on the method of application, are divided into 2 groups - local and systemic:

  1. Local - vaginal cream, tablets or suppositories.
    Benefits: safer, do not form resistance to them in fungi, create a high concentration of the substance with its minimal systemic effect, avoid unwanted side effects. Many of them can be used during pregnancy.
    disadvantages: If the focus of a fungal infection is located, for example, in the intestines, local remedies will be ineffective.
    Topical preparations (cream, tablets or suppositories) are injected deep into the vagina 1 to 2 times a day, in the morning and in the evening before bedtime. Treatment is carried out until recovery, on average 5-7 days, but with chronic thrush, it may take a longer time. Intravaginal forms of drugs are not used during menstruation.
    Local treatment is most often quite sufficient for new-onset thrush and its mild course.
  2. Systemic - taken orally tablets or capsules, which are absorbed from the intestine into the bloodstream and penetrate into all organs, tissues and cells of the body.
    Benefits: allow you to affect other foci of infection (for example, the intestines), as well as fungi that live in the thickness of the walls of the vagina, and not only on its surface.
    disadvantages: have a large number of side effects and toxicity, including hepatotoxicity. Therefore, their use during pregnancy is contraindicated. The exception is non-toxic, but ineffective pimafucin.
    Systemic drugs are used in case of ineffectiveness of adequate local treatment or with frequent relapses of thrush (more often 4 times a year).

By the mechanism of action on fungi, antifungal agents are:

  1. Preparations with fungicidal action - those that directly damage fungi and cause their death. Most often these are agents for local use, because when using them, a very high concentration of the drug is created, sufficient to ensure direct damage and death of the fungus.
  2. Preparations with fungistatic action - those that suppress the reproduction of fungi, disrupting the synthesis of individual components necessary to build the membrane of its cell. In this case, new mushrooms cannot form, but existing ones do not die. After removal of the fungistatic agent, growth resumes again. This mechanism of action is typical for systemic therapy drugs.

However, the most appropriate is the use of drugs that have both fungistatic and fungicidal effects.

Local antifungal agents for the treatment of thrush (5 groups).
(International names are given first, commercial names in brackets).

1. The largest and most frequently used group of antifungal drugs is azoles.
They block the synthesis of ergosterol, the main component of the cell wall of fungi. Without ergosterol, the integrity of the cell membrane is disrupted, the intracellular components of the fungus enter the extracellular space and the fungi die. Fortunately, ergosterol is not a component of the human cell membrane and azoles do not harm them.

  • Clotrimazole (Amiclone, Candide B6 Antifungol, Candibene, Canesten, Kanizon, Clotrimazole).
  • Ketoconazole (Livarol, Lotseril).
  • Fenticonazole (Lomexin).
  • Isoconazole (Gyno-Travogen Ovulum).
  • Miconazole (Ginesol 7, Gyno-dactarine).
  • Butoconazole (Gynofort)

All these funds have the same mechanism of action and have approximately the same effectiveness, which depends on the sensitivity of the fungal flora to a particular drug.

2. Polyene antibiotics. They are used much less frequently, because less effective.

  • Natamycin (Pimafucin, Primafungin)

3. Povidone-Iodine (Betadine, Iodoxide, Vokadin) - iodine compounds, contraindicated in case of thyroid dysfunction and during pregnancy, because may interfere with the formation of the thyroid gland in the fetus.

4. Combined drugs, including antibiotics and hormones.

  • Klion-D 100 (miconazole + metronidazole)
  • Polygynax (Neomycin + Polymyxin B sulfate + Nystatin)
  • Terzhinan (neomycin + nystatin + prednisone)

The use of combined drugs, including broad-spectrum antibiotics and hormones, is impractical for thrush, since they suppress the normal microflora of the vagina.

5. 5-10% borax solution in glycerin. Currently, it is practically not used, because it is an ineffective method of treating thrush.

Antifungal drugs for systemic use in thrush (3 groups).

1. Group of "azoles" of systemic action.

  • Fluconazole (Diflucan, Diflazon, Tsiskan, Flucostat, Medoflucon, Forcan, Mikosist, Fluconazole).
    With a fresh episode of thrush, it is sufficient to take fluconazole at a dose of 150 mg twice with an interval of 3 days. With often exacerbated thrush after such a double dose, 150 mg is prescribed once a week for 6 months. There is also a treatment regimen in which fluconazole is taken at 150 mg 2 weeks every three days. Fluconazole has high bioavailability and effectiveness, it penetrates into all body tissues, has low toxicity and frequency of side effects. The disadvantage is that C. albicans may develop resistance to fluconazole over time. If treatment with fluconazole does not give an effect, one should think about candidiasis caused by naturally resistant Candida species. In such cases, antifungal therapy with an effective but potentially toxic amphotericin B is recommended.
  • Ketoconazole (Nizoral). The average dose is 200 mg 2 times a day or 400 mg 1 time a day with meals. The average course of treatment is 7 days. Ketoconazole in the form of tablets has a predominantly fungistatic effect, but when applied topically in the form of creams and suppositories, its high concentration (1-2%) is created, which is sufficient for the development of a fungicidal effect.
  • Itraconazole. With thrush, take 0.2 g 2 times a day 1 day or 0.2 g 1 time per day for 3 days. In chronic recurrent fungal vulvovaginitis - 0.2 g 2 times a day for 7 days, and then for 3-6 menstrual cycles, 0.2 g on the first day of the cycle.

2. Polyene antibiotics

  • Natamycin (Pimafucin, Primafungin). The efficiency is low.
  • Nystatin. Currently not used, because is ineffective.
  • Amphotericin B. An effective drug, however, it is used only for serious systemic fungal infections, because is extremely toxic. It is not intended to treat fungal infections such as thrush. The only exceptions are cases of persistent, refractory treatment by other means, including fluconazole, severe candidiasis. But in these cases, treatment is carried out in a hospital.

Important! In all cases, when one cannot do without the systemic agents of these 2 groups, it is necessary to take hepatoprotectors - drugs that protect the liver from toxic effects.

3. Caprylic acid (Candida Clear). It is a fatty acid found in coconut and palm oils. Caprylic acid inhibits the growth of yeast fungi, and especially the genus Candida, and also maintains the normal balance of microorganisms in the intestine. This agent has no toxic effect and therefore can be used without hepatoprotectors.

The general scheme for the treatment of thrush in women, depending on the course of the disease.

I. First-onset thrush and mild course.
Most often, with a first-onset thrush and a mild course, it is enough to use drugs for topical use. These can be suppositories, creams or tablets with clotrimazole, ketoconazole, fenticonazole, or others. For example:
- Lomexin (600 mg capsules) - one capsule intravaginally, repeat after 3 days.
- Or Livarol (400 mg vaginal suppositories) - 1 suppository per day for 5 days.
- Or Pimafucin - 1 vaginal suppository for 5-6 days.
Local treatment is not used during menstruation.
In addition, with a mild course of thrush, instead of drugs for topical use, a single dose of fluconazole at a dosage of 150 mg orally is possible. Occasionally, it becomes necessary to repeat the appointment after 3 days. However, one must remember about the toxicity of fluconazole.

II. Chronic or recurrent thrush (more than 4 exacerbations per year). In these cases, a combination therapy of systemic and local antimycotics is required.
Local remedies (suppositories, creams or tablets) with clotrimazole, ketoconazole, fenticonazole, or others are prescribed 2 times a day for at least 2 weeks, followed by supportive therapy.
Simultaneously with local agents, systemic drugs Fluconazole are used - 150 mg orally for 1, 4, 7 days, or for 10 days, then 1 capsule per week for 6 months.
For example:
Livarol (400 mg vaginal suppositories) are prescribed 1 suppository (400 mg) 2 times a day for 10 days and then 1 suppository a day for 5 days before each menstruation for 6 months. At the same time, Fluconazole (150 mg) is prescribed according to the above scheme.

Treatment of candidiasis (thrush) in men

As in women, when treating candidiasis in men, it is important not only to get rid of the fungus, but also to eliminate factors predisposing to it, for example, an abundance of sweets in food.
With candidiasis balanoposthitis (lesion of the glans penis and foreskin), local treatment is sufficient. Apply a cream with clotrimazole, ketoconazole, or fenticonazole. It is applied in a thin layer on the glans penis and foreskin 2 times a day for 8-10 days.
A single dose of fluconazole 150 mg is also possible.

Treatment of thrush in sexual partners

According to modern concepts, treatment of a sexual partner in the absence of symptoms of the disease is optional, but desirable.
However, if a woman has a chronic recurrent process, her partner should be examined. If fungi are found, treatment should be carried out regardless of the clinical condition.

When treating a couple, the following treatment regimen is usually prescribed:
Fluconazole (150mg) for both partners: a single dose is enough for a man, a woman should be repeated after 3 days.
It is also imperative to apply local remedies at the same time. Suppositories with Ketoconazole - for a woman. For a man - a cream with Ketoconazole on the head of the penis. The duration of treatment depends on the form of the disease - acute or chronic.
During treatment, it is better to abstain from sexual activity.

What to look out for before starting treatment.

Before starting treatment of thrush with antifungal drugs, it should be borne in mind that many of them, especially of systemic action, have a number of side effects, and are extremely toxic to the liver and kidneys. Moreover, the use of systemic antifungal agents is sometimes contraindicated or unreasonable, therefore it is necessary to compare the risk from thrush and the risk from taking these funds.

In any case, before immediately resorting to taking systemic antifungal drugs, it is advisable:

  1. Consider whether you have taken antibiotics, hormonal drugs, including contraceptives, or immunosuppressants in the near future, which could disrupt the composition of the normal vaginal microflora or lead to a decrease in immunity.
  2. Pay attention to your diet. Is there too much carbohydrates in it - sugar, buns and cakes, which create a favorable environment for the growth of mushrooms?
  3. Do you often douche? After all, this removes useful microflora.
  4. Take a blood sugar test, because thrush can often be the first sign of onset diabetes, and dietary changes can be beneficial.
    All of the above factors can provoke the development of the disease, and if they are not eliminated, the use of even the most powerful means may be ineffective.

All drugs should be prescribed by the attending physician, taking into account individual indications, contraindications, propensity to allergies, liver and kidney conditions, etc.

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