Vaginitis: Trichomoniasis, Candidiasis, Bacterial Vaginosis Tóm tắt về thuốc

Cập nhật: 18 March 2026
Được đánh giá bởi

Azoles (Oral)

DRUGS FOR VULVOVAGINAL CANDIDIASIS

Drug Dosage Remarks
Fluconazole 150 mg PO as a single
dose
Recurrent vaginal
candidiasis:
150 mg PO monthly x
4-12 months or 150 mg PO 24 hourly on day 1, 4 and 7
followed by 150 mg PO 24 hourly weekly x 6 months		 Adverse Reactions
  • CNS effects (headache, dizziness); GI effects (abdominal pain, diarrhea, flatulence, nausea/vomiting, taste disturbance, elevated liver enzymes); Endocrine effects (hypertriglyceridemia, hypokalemia); Dermatologic effects (rash, alopecia)
  • Rarely: Anaphylaxis, QT prolongation, torsade de pointes
Special Instructions
  • Use with caution in patients with renal and hepatic impairment
Itraconazole 200 mg PO 12 hourly x
1 day or 200 mg PO
24 hourly x 3 days		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal pain, nausea); Dermatologic effects (rash, pruritus, urticaria, very rarely Stevens-Johnson syndrome); CNS effects (fever, headache, fatigue); Respiratory effects (dyspnea, rhinitis); CV effects (edema, hypertension, chest pain)
Special Instructions
  • Avoid in patients with active liver disease or elevated liver enzymes
  • Use with caution in patients with risk factors for heart failure (ie COPD, renal impairment, ischemic or valvular disease)
  • Discontinue treatment if signs and symptoms of neuropathy occur
  • Contraception is advised during and 2 months after treatment
Ketoconazole 200 mg PO 24 hourly x
3-10 days or 400 mg PO 24 hourly x 5 days		 Adverse Reactions
  • GI effects (nausea/vomiting, abdominal pain, serious hepatotoxicity); Dermatologic effects (urticaria, angioedema, pruritus, rash, alopecia); CNS effects (headache, dizziness, somnolence)
Special Instructions
  • Use only to treat serious fungal infection when other therapies are not tolerated or unavailable
    • Carefully consider the benefits against potential risks of therapy
  • Contraindicated in patients with acute or chronic liver disease
  • Use with caution in patients with adrenal insufficiency
  • Monitor LFTs at baseline and weekly during treatment course
Oteseconazole Monotherapy
Day 1: 600 mg PO
Day 2: 450 mg PO
Day 14: 150 mg PO
weekly x 11 weeks
Combination with
Fluconazole
Day 14-20: 150 mg PO 24 hourly x 7 days
Day 28: 150 mg PO
weekly x 11 weeks		 Adverse Reactions
  • GI effect (nausea); CNS effect (headache)
Special Instructions
  • Contraindicated in patients with severe renal impairment, end-stage renal disease, moderate or severe hepatic impairment, females of reproductive potential, and in pregnant and lactating women

Azoles (Vaginal)

DRUGS FOR TRICHOMONIASIS

Drug Available Strength Dosage Remarks
Imidazoles
Clotrimazole1 100 mg vaginal cap, tab, insert
200 mg vaginal tab
500 mg vaginal cap, tab		 100 mg vaginally at bedtime x
6-7 days or
200 mg vaginally at bedtime x 3 days or
500 mg vaginally at bedtime as a single dose		 Adverse Reactions
  • GI effects (abdominal pain, cramping); GU effects (pelvic pain, vaginal itching, burning, soreness, burning or itching of penis of sexual partner)
Special Instructions
  • Discontinue use if irritation occurs
  • Avoid intercourse while on therapy
Tinidazole/tioconazole/
lidocaine		 Tinidazole 300 mg/tioconazole 200 mg/lidocaine 100 mg vaginal suppository Insert 1 suppository high into vagina at night x 3 days Adverse Reactions
  • GI effects (nausea/vomiting, loss of appetite, dyspepsia, abdominal cramps, constipation, flatulence); CNS effects (headache, dizziness); Other effects (weakness, fatigue, malaise, metallic/bitter taste, darkened urine)
Special Instructions
  • Contraindicated during first trimester of pregnancy and while breastfeeding
  • Avoid during menstruation and do not use with other vaginal products
  • Avoid in patients with organic neurologic disorders and history or existing blood dyscrasia
1Combination with Clindamycin is available. Please see the latest MIMS for specific formulations and prescribing information.

DRUGS FOR BACTERIAL VAGINOSIS

Drug Available Strength Dosage Remarks
Imidazoles
Clotrimazole1 100 mg vaginal tab,
500 mg vaginal tab		 100 mg vaginally at bedtime
x 6-7 days or
500 mg vaginally at bedtime as a single dose		 Adverse Reactions
  • GI effects (abdominal pain, cramping); GU effects (pelvic pain, vaginal itching, burning, soreness, burning or itching of penis of sexual partner)
Special Instructions
  • Discontinue use if irritation occurs
  • Avoid intercourse while on therapy
Tinidazole/tioconazole/
lidocaine		 Tinidazole 300 mg/tioconazole 200 mg/lidocaine
100 mg vaginal suppository		 Insert 1 suppository high into vagina at night x 3 days Adverse Reactions
  • GI effects (nausea/vomiting, loss of appetite, dyspepsia, abdominal cramps, constipation, flatulence); CNS effects (headache, dizziness); Other effects (weakness, fatigue, malaise, metallic/bitter taste, darkened urine)
Special Instructions
  • Contraindicated during first trimester of pregnancy and while breastfeeding
  • Avoid during menstruation and do not use with other vaginal products
  • Avoid in patients with organic neurologic disorders and history or existing blood dyscrasia
1Combination with Clindamycin is available. Please see the latest MIMS for specific formulations and prescribing information.

DRUGS FOR VULVOVAGINAL CANDIDIASIS 

Drug Available Strength Dosage Remarks
Imidazoles Adverse Reactions
  • GI effects (abdominal pain, cramping); GU effects (pelvic pain, vaginal itching, burning, soreness, burning or itching of penis of sexual partner)
  • Tinidazole/tioconazole/lidocaine: GI effects (nausea/vomiting, loss of appetite, dyspepsia, abdominal cramps, constipation, flatulence); CNS effects (headache, dizziness); Other effects (weakness, fatigue, malaise, metallic/bitter taste, darkened urine)
Special Instructions
  • Discontinue use if irritation occurs
  • Creams and suppositories are oil-based which may weaken latex condoms and diaphragms necessitating additional contraceptive measures
  • Avoid intercourse while on therapy
  • Tinidazole/tioconazole/lidocaine:
    • Contraindicated during first trimester of pregnancy and while breastfeeding
    • Avoid during menstruation and do not use with other vaginal products
    • Avoid in patients with organic neurologic disorders and history or existing blood dyscrasia
Butoconazole 2% vaginal cream 1 applicatorful (5 g) vaginally at bedtime as a single dose
Clotrimazole1 1%, 10% vaginal cream 1 applicatorful (5 g) vaginally at bedtime x 7-14 days
2% vaginal cream, gel 1 applicatorful (5 g) vaginally at bedtime x 3 days
100 mg vaginal cap, tab, suppository, insert, pessary 100 mg vaginally at bedtime x 6-7 days or
200 mg vaginally at bedtime x 3 days
200 mg vaginal tab, suppository 200 mg vaginally at bedtime x 3-7 days
500 mg vaginal cap, tab, suppository 500 mg vaginally at bedtime as a single dose
Econazole 50 mg vaginal suppository 50 mg vaginally at bedtime x 6 days
150 mg vaginal ovule,
pessary, suppository, tab		 150 mg vaginally at bedtime x 3 days
150 mg depot vaginal ovule 150 mg vaginally 12 hourly x 1 day
Fenticonazole
(Fenticonazole nitrate)		 2% vaginal cream 1 applicatorful (5 g) vaginally 12 hourly
200 mg vaginal cap, ovule, pessary 200 mg vaginally at bedtime x 3 days
600 mg vaginal pessary 600 mg vaginally at bedtime
Isoconazole 1% vaginal cream Apply 24 hourly x 7 days
300 mg vaginal tab 300 mg vaginally 24 hourly x 3 days
600 mg vaginal ovule 600 mg vaginally as a single dose
600 mg vaginal pessary 600 mg vaginally as a single dose or
300 mg vaginally 24 hourly x 3 days
Miconazole2 2% vaginal cream 1 applicatorful (5 g) vaginally at bedtime x 7-14 days or
1 applicatorful (5 g) vaginally 12 hourly x 7 days
4% vaginal cream 1 applicatorful (5 g) vaginally at bedtime x 3 days
400 mg vaginal ovule 200-400 mg vaginally at bedtime x 3 days
100 mg vaginal suppository 100 mg vaginal suppository at bedtime x 7 days
200 mg vaginal suppository 200 mg vaginal suppository at bedtime x 3 days
1,200 mg vaginal suppository 1,200 mg vaginal suppository at bedtime as a single dose
100 mg vaginal tab 100 mg vaginally at bedtime x 7-14 days
Sertaconazole 300 mg vaginal suppository,
ovule		 300 mg vaginally at bedtime as a single dose; may repeat in 7 days
500 mg vaginal tab 500 mg vaginally at bedtime as a single dose; may repeat in 1-2 weeks
Tinidazole/tioconazole/lidocaine Tinidazole 300 mg/tioconazole 200 mg/lidocaine 100 mg vaginal
suppository		 Insert 1 suppository high into vagina at night x 3 days
Tioconazole 6.5% vaginal ointment 1 applicatorful (5 g) vaginally at bedtime as a single dose
Triazole
Terconazole 0.4% vaginal cream 1 applicatorful (5 g) vaginally at bedtime x 7 days
0.8% vaginal cream 1 applicatorful (5 g) vaginally x 3 days
80 mg vaginal suppository 80 mg vaginal suppository at bedtime x 3 days
1Various combinations of Clotrimazole are available. Please see the latest MIMS for specific formulations and prescribing information.
2Various combinations of Miconazole are available. Please see the latest MIMS for specific formulations and prescribing information.

Lincosamide (Oral)

DRUGS FOR BACTERIAL VAGINOSIS
Drug Dosage Remarks
Clindamycin 150-300 mg PO 6 hourly or
300 mg PO 12 hourly x 7 days		 Adverse Reactions
  • Prolonged use may result in fungal or bacterial superinfection
  • Dermatologic effects (pruritus, urticaria); GI effects (abdominal pain, nausea/vomiting, esophagitis); Hematologic effects (transient neutropenia or eosinophilia); Hepatic effects (jaundice, elevated LFTs)
Special Instructions
  • May be taken with food to decrease GI upset
    • Take with at least 8 oz of water and advise patient to sit up for at least 30 minutes after taking the drug
  • Discontinue if diarrhea or passage of blood or mucus occurs
  • Use with caution in patients with history of GI disease, severe hepatic impairment, atopy

Lincosamide (Vaginal)

DRUGS FOR BACTERIAL VAGINOSIS
Drug Available Strength Dosage Remarks
Clindamycin1 2% vaginal cream 1 applicatorful (5 g) intravaginally at bedtime x
3-7 days		 Adverse Reactions
  • Vaginitis or vulvovaginal pruritus, vaginal pain, fungal infection
  • Rarely systemic effects (diarrhea, nausea/vomiting, allergic reaction)
Special Instructions
  • Discontinue if diarrhea occurs
  • Avoid in patients with history of pseudomembranous colitis, regional enteritis, ulcerative colitis
  • Insert as far as possible without causing discomfort
  • May weaken latex condoms and diaphragms necessitating additional contraceptive measures; do not use within 72 hours after treatment with Clindamycin ovules
100 mg vaginal
suppository, cap		 100 mg
intravaginally at
bedtime x
3-7 days
1Various combinations of Clindamycin are available. Please see the latest MIMS for specific formulations and prescribing information.

Nitroimidazole Derivatives (Oral)

DRUGS FOR TRICHOMONIASIS
Drug Dosage Remarks
Metronidazole Recommended regimens:
2-2.5 g PO as a single dose or
250-500 mg PO 12 hourly x 6-7 days
Alternative regimens:
200-250 mg PO 8 hourly x 7-10 days
or 400-800 mg PO 8 hourly x 5-10 days
or 600 mg-1 g/day PO divided
8-12 hourly
or 750 mg PO 24 hourly x 10 days
or 800 mg PO in morning and 1.2 g
PO in evening x 2 days		 Adverse Reactions
  • GI effects (nausea/vomiting, metallic taste, diarrhea, constipation, abdominal cramping, epigastric distress); CNS effects (weakness, dizziness, headache, mood changes); CV effects (flattening of T-wave, flushing, syncope); Hematologic effects (reversible neutropenia or thrombocytopenia); Metabolic effect (disulfiram-like reaction); Dermatologic effects (rash, pruritus)
  • High dose or prolonged use has caused CNS effects (eg peripheral neuropathy, seizures, aseptic meningitis) or fungal/bacterial infection (eg pseudomembranous colitis, candidal infection)
Special Instructions
  • May be taken with food to decrease GI upset
  • Avoid alcohol intake during treatment and until 24 hours after completion of Metronidazole or 72 hours after Tinidazole
  • Avoid in patients on first trimester; interrupt breastfeeding while on treatment and until 1 day after completion of Metronidazole or 3 days after Tinidazole
  • Use with caution in patients with severe hepatic impairment, seizure disorder, blood dyscrasia, heart failure, edema, sodium-retaining state
  • If given >10 days, recommend monitoring CBCs and clinical monitoring for CNS effects
Ornidazole 1.5 g PO as single dose
Secnidazole 2 g PO as a single dose or divided
12 hourly
Tinidazole 2 g PO as a single dose

DRUGS FOR BACTERIAL VAGINOSIS
Drug Dosage Remarks
Metronidazole Recommended regimen: 400-500 mg PO 12 hourly x 5-7 days
Alternative regimen: 2 g PO as a single dose
Extended-release: 750 mg PO 24 hourly x 7 days
Pregnant patients after first trimester: 200-250 mg PO 8 hourly x 7 days or
500 mg PO 12 hourly x 7 days		 Adverse Reactions
  • GI effects (nausea/vomiting, metallic taste, diarrhea, constipation, abdominal cramping, epigastric distress); CNS effects (weakness, dizziness, headache, mood changes); CV effects (flattening of T-wave, flushing, syncope); Hematologic effects (reversible neutropenia or thrombocytopenia); Metabolic effect (disulfiram-like reaction); Dermatologic effects (rash, pruritus)
  • High dose or prolonged use has caused CNS effects (eg peripheral neuropathy, seizures, aseptic meningitis) or fungal/bacterial infection (eg pseudomembranous colitis, candidal infection)
Special Instructions
  • May be taken with food to decrease GI upset
  • Avoid alcohol intake during treatment and until 24 hours after completion of Metronidazole or 72 hours after Tinidazole
  • Avoid in patients on first trimester; interrupt breastfeeding while on treatment and until 1 day after completion of Metronidazole or 3 days after Tinidazole
  • Use with caution in patients with severe hepatic impairment, seizure disorder, blood dyscrasia, heart failure, edema, sodium-retaining state
  • If given >10 days, recommend monitoring CBCs and clinical monitoring for CNS effects
Secnidazole 2 g PO as a single dose
Tinidazole 2 g PO as a single dose or 2 g PO 24 hourly x 2 days or 1 g PO 24 hourly x 5 days

Nitroimidazole Derivative (Vaginal)

DRUGS FOR TRICHOMONIASIS
Drug Available Strength Dosage Remarks
Metronidazole1 500 mg ovule 500 mg-1 g vaginally 24 hourly Adverse Reactions
  • GUT effects (vaginal discharge, Candida cervicitis or vaginitis, vaginal irritation); Less common local effects (dysuria, vulvitis, dark urine, burning sensation of penis of sexual partner)
  • Less common systemic effects (diarrhea, nausea/vomiting, altered taste sensation)
Special Instructions
  • Clean and dry skin prior to application
500 mg vaginal suppository 500 mg vaginally at bedtime x 10-20 days
500 mg pessary 1 pessary 24 hourly x
10 days
250 mg vaginal suppository 250 mg vaginally 6 hourly x
10-21 days
250 mg pessary 1 pessary 24 hourly x 10-21 days
750 mg vaginal suppository 750 mg vaginally at bedtime x 7 days
1Various combinations of Metronidazole are available. Please see the latest MIMS for specific formulations and prescribing information.

DRUGS FOR BACTERIAL VAGINOSIS

Drug Available Strength Dosage Remarks
Metronidazole1 0.75% gel 1 applicatorful (5 g) intravaginally at bedtime or 12 hourly x 5 days Adverse Reactions
  • GUT effects (vaginal discharge, Candida cervicitis or vaginitis, vaginal irritation); Less common local effects (dysuria, vulvitis, dark urine, burning sensation of penis of sexual partner)
  • Less common systemic effects (diarrhea, nausea/vomiting, altered taste sensation)
Special Instructions
  • Clean and dry skin prior to application
1.3% gel 1 applicatorful (5 g) intravaginally at bedtime as single dose
500 mg vaginal cap, suppository 500 mg vaginally 24 hourly x 7-20 days
750 mg vaginal suppository 750 mg vaginally at bedtime x 7 days
1Various combinations of Metronidazole are available. Please see the latest MIMS for specific formulations and prescribing information.

Preparations for Vaginal Conditions

DRUGS FOR TRICHOMONIASIS
Drug Available Strength Dosage Remarks
Dequalinium Cl 10 mg vaginal tab 1 vaginal tab at bedtime x
6 days		 Adverse Reactions
  • Local effects (itching, pain, discomfort, irritation)
Special Instructions
  • Dequalinium Cl should not be used in patients with vaginal ulceration or in young girls who have not reached sexual maturity
    • Discontinue use while with menstruation
    • Use with caution during first trimester of pregnancy
  • Use Povidone-iodine with caution in patients with thyroid diseases
Povidone-iodine 200 mg pessary 1 pessary nightly x 2 weeks regardless of menstruation
7.5% cleanser Wash on external genitalia for ≤60 seconds morning and evening
10% vaginal gel Insert 1 applicatorful nightly x 2 weeks including days of the menstrual cycle
10% vaginal douche Apply solution intravaginally
24 hourly x 14 days even
with menstruation

DRUGS FOR BACTERIAL VAGINOSIS

Drug Available Strength Dosage Remarks
Carbomer/Polycarbophil - Prevention: Apply once
every 3 days
Treatment: Apply 24 hourly
x 1 week		 Adverse Reactions
  • Local effects (itching, pain, discomfort, irritation)
Special Instructions
  • Do not use Chlorhexidine digluconate everyday for >2 weeks
  • Dequalinium Cl should not be used in patients with vaginal ulceration or in young girls who have not reached sexual maturity
    • Discontinue use while with menstruation
    • Use with caution during first trimester of pregnancy
  • Discontinue Hexetidine in case of burning sensation in the vagina
    • Avoid use during first trimester of pregnancy
  • Discontinue Lactic acid/Lactoserum and seek medical advice if symptoms persist after 7 days, condition causes itching or pain, or discharge contains blood
  • Avoid L acidophilus/Estriol in patients with malignant changes in the breast, uterus or vagina, suspected endometriosis, vaginal hemorrhaging of unknown origin, young girls who have not reached sexual maturity
    • Treatment should be interrupted during menstruation; do not use vaginal douches during treatment
  • Use Povidone-iodine with caution in patients with thyroid diseases
Chlorhexidine digluconate 0.2% liquid soap Apply 5-10 mL on external genitalia then rinse
Dequalinium Cl 10 mg vaginal tab 1 vaginal tab at bedtime x
6 days
Hexetidine 10 mg vaginal tab 1 vaginal tab in the morning
and evening
Lactic acid1/Lactoserum Lactic acid 1 g/Lactoserum 0.9 g per 100 mL wash Irrigate vaginally daily during treatment
Lactobacillus acidophilus/Estriol L acidophilus 100 million
organisms/Estriol 30 mcg vaginal tab		 1-2 vaginal tab at bedtime x
6-12 days
Lactobacillus rhamnosus/Lactobacillus reuteri L rhamnosus 2.5 x 109 CFU/L reuteri 2.5 x 109 CFU cap Prophylaxis: 1 cap PO
24 hourly x 3 weeks at 4 monthly intervals, to be given prior to menstrual period when imbalance of vaginal flora occurs
Therapy: 2 cap PO 24 hourly, to be taken in the first day of antibiotic therapy to
3 weeks after discontinuation of antibiotic
Povidone-iodine 200 mg pessary 1 pessary nightly x 2 weeks
regardless of menstruation
7.5% cleanser Wash on external genitalia for ≤60 seconds morning and evening
10% vaginal gel Insert 1 applicatorful
nightly x 2 weeks including
days of the menstrual
cycle
10% vaginal douche Apply solution intravaginally
24 hourly x 14 days even with menstruation
1Other Lactic acid preparations and combinations with other products are available. Please see the latest MIMS for specific formulations and prescribing information.

DRUGS FOR VULVOVAGINAL CANDIDIASIS

Drug Available Strength Dosage Remarks
Dequalinium Cl 10 mg vaginal tab 1 vaginal tab at bedtime x 6 days Adverse Reactions
  • Local effects (itching, pain, discomfort, irritation)
Special Instructions
  • Dequalinium Cl should not be used in patients with vag ulceration or in young girls who have not reached sexual maturity
    • Discontinue use while with menstruation
    • Use with caution during first trimester of pregnancy
  • Avoid L acidophilus/Estriol in patients with malignant changes in the breast, uterus or vagina, suspected endometriosis, vaginal hemorrhaging of unknown origin, young girls who have not reached sexual maturity
    • Treatment should be interrupted during menstruation; do not use vaginal douches during treatment
  • Use Povidone-iodine with caution in patients with thyroid diseases
Lactobacillus
acidophilus/Estriol		 L acidophilus
100 million
organisms/Estriol
30 mcg vaginal tab		 1-2 vaginal tab at bedtime x
6-12 days
Lactobacillus
plantarum		 L plantarum
≥100 million cells/
vaginal tab		 1 vaginal tab at bedtime on
alternate days x 2 weeks at the end of menstrual period
Lactobacillus
rhamnosus/
Lactobacillus
reuteri		 L rhamnosus
2.5 x 109 CFU/L reuteri 2.5 x 109 CFU cap		 Prophylaxis: 1 cap PO 24 hourly x
3 weeks at 4 monthly intervals, to be
given prior to menstrual period
when imbalance of vaginal flora
occurs
Therapy: 2 cap PO 24 hourly, to
be taken in the first day of
antibiotic therapy to 3 weeks after
discontinuation of antibiotic
Povidone-iodine 200 mg pessary 1 pessary nightly x 2 weeks
regardless of menstruation
7.5% cleanser Wash on external genitalia for
≤60 seconds morning and evening
10% vaginal gel Insert 1 applicatorful nightly x
2 weeks including days of the
menstrual cycle
10% vaginal douche Apply solution intravaginally 24 hourly x
14 days even with menstruation

Polyene Antifungal (Vaginal)

DRUGS FOR VULVOVAGINAL CANDIDIASIS
Drug Available Strength Dosage Remarks
Nystatin1 100,000 IU vaginal tab, cream 200,000 IU vaginally 24 hourly x 14 days or
100,000 IU vaginally 12-24 hourly x 14 days		 Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, abdominal pain); Dermatologic effects (contact dermatitis, Stevens-Johnson syndrome)
Special Instructions
  • Insert high into vagina while lying down at bedtime
1Various combinations of Nystatin are available. Please see the latest MIMS for specific formulations and prescribing information.

Topical Anti-infectives with Corticosteroids

DRUGS FOR VULVOVAGINAL CANDIDIASIS
Drug Available Strength Dosage Remarks
Clotrimazole/Beclomethasone
dipropionate		 Lotion, 1% cream Apply to affected area 8-12 hourly Adverse Reactions
  • Miliaria, folliculitis or pyoderma, localized atrophy and striae
Special Instructions
  • Use with caution if for extensive and prolonged use, use with occlusive dressing
  • Avoid in patients with skin TB, herpes simplex, chickenpox, measles, vaccinia, syphilitic skin lesions

Disclaimer

All dosage recommendations are for non-elderly adults with normal renal and hepatic function unless otherwise stated. 
Not all products are available or approved for above use in all countries. 
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information. 

Thuốc có trên MIMS có liên quan