What are effective interventions for chronic or recurrent yeast vaginitis?

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EVIDENCE-BASED ANSWERInduction of clinical remission with oral fluconazole followed by once-weekly suppressive therapy for 6 months decreases recurrence of yeast vaginitis during suppression by 19% (number needed to treat [NNT]=6) compared with placebo (SOR: A, meta-analysis of RCTs). Intravaginal nystatin for 14 days monthly for 6 months is as effective as once-weekly oral fluconazole suppression, but is more effective in cases caused by Candida glabrata (SOR: B, single RCT). When measuring short-term (1 month) outcomes in patients with recurrent disease, boric acid suppositories are more effective than nystatin, but similar to fluconazole. In the subset of cases caused by C glabrata, boric acid is more likely to be effective than fluconazole (SOR: B, systematic review not limited to RCTs).

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