Editing Candidiasis (section)

== Treatment ==

Candidiasis is treated with [[antifungal medication]]s; these include [[clotrimazole]], [[nystatin]], [[fluconazole]], [[voriconazole]], [[amphotericin B]], and [[echinocandin]]s.<ref name=IDSA2016 />  Intravenous fluconazole or an intravenous echinocandin such as [[caspofungin]] are commonly used to treat immunocompromised or critically ill individuals.<ref name=IDSA2016/>

The 2016 revision of the [[clinical practice guideline]] for the management of candidiasis lists a large number of specific treatment regimens for ''Candida'' infections that involve different ''Candida'' species, forms of [[Antimicrobial resistance|antifungal drug resistance]], immune statuses, and infection localization and severity.<ref name=IDSA2016 /> Gastrointestinal candidiasis in immunocompetent individuals is treated with 100–200&nbsp;mg<!--dosage is included here because the cited ref is the only secondary source (as of June 2016) that gives a treatment protocol for immunocompetent GI candidiasis--> fluconazole per day for 2–3&nbsp;weeks.<ref name="SIFO" />

=== Localized infection ===
Mouth and throat candidiasis are treated with antifungal medication. Oral candidiasis usually responds to topical treatments; otherwise, systemic antifungal medication may be needed for oral infections. Candidal skin infections [[candidal intertrigo|in the skin folds (candidal intertrigo)]] typically respond well to topical antifungal treatments (e.g., [[nystatin]] or [[miconazole]]). For breastfeeding mothers topical miconazole is the most effective treatment for treating candidiasis on the breasts.<ref>{{Cite journal|last=Walker|first=Marsha|date=2008|title=Conquering Common Breast-feeding Problems|journal=The Journal of Perinatal & Neonatal Nursing|language=en|volume=22|issue=4|pages=267–274|doi=10.1097/01.JPN.0000341356.45446.23|pmid=19011490|s2cid=27801867|issn=0893-2190}}</ref> [[Gentian violet]] can be used for thrush in [[breastfeeding]] babies.<ref name="Walker_2008" /> Systemic treatment with antifungals by mouth is reserved for severe cases or if treatment with topical therapy is unsuccessful. Candida esophagitis may be treated orally or intravenously; for severe or azole-resistant esophageal candidiasis, treatment with amphotericin B may be necessary.<ref name=CDC2014Otx/>

Vaginal yeast infections are typically treated with topical antifungal agents.<ref name=IDSA2016 /> Penile yeast infections are also treated with antifungal agents, but while an internal treatment may be used (such as a pessary) for vaginal yeast infections, only external treatments&nbsp;– such as a cream&nbsp;– can be recommended for penile treatment.<ref>{{Cite web|title=Male thrush: everything you need to know|url=https://www.medino.com/article/what-is-male-thrush-symptoms-treatment|access-date=2021-05-19|website=medino|language=en|archive-date=2021-05-19|archive-url=https://web.archive.org/web/20210519094911/https://www.medino.com/article/what-is-male-thrush-symptoms-treatment|url-status=live}}</ref> A one-time dose of fluconazole by mouth is 90% effective in treating a vaginal yeast infection.<ref name=Moosa>{{cite journal | vauthors = Moosa MY, Sobel JD, Elhalis H, Du W, Akins RA | title = Fungicidal activity of fluconazole against Candida albicans in a synthetic vagina-simulative medium | journal = Antimicrobial Agents and Chemotherapy | volume = 48 | issue = 1 | pages = 161–7 | date = January 2004 | pmid = 14693534 | pmc = 310176 | doi = 10.1128/AAC.48.1.161-167.2004 }}</ref> For severe nonrecurring cases, several doses of fluconazole is recommended.<ref name=IDSA2016 /> Local treatment may include vaginal [[suppository|suppositories]] or medicated [[douche]]s. Other types of yeast infections require different dosing.  ''C. albicans'' can develop resistance to fluconazole, this being more of an issue in those with HIV/AIDS who are often treated with multiple courses of fluconazole for recurrent oral infections.<ref>{{cite journal | vauthors = Morschhäuser J | title = The genetic basis of fluconazole resistance development in Candida albicans | journal = Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease | volume = 1587 | issue = 2–3 | pages = 240–8 | date = July 2002 | pmid = 12084466 | doi = 10.1016/s0925-4439(02)00087-x | doi-access = free }}</ref>

For vaginal yeast infection in [[pregnancy]], topical [[imidazole]] or [[triazole]] antifungals are considered the therapy of choice owing to available safety data.<ref name="soong2009"/> Systemic absorption of these topical formulations is minimal, posing little risk of [[transplacental]] transfer.<ref name="soong2009"/> In vaginal yeast infection in pregnancy, treatment with topical azole antifungals is recommended for seven days instead of a shorter duration.<ref name="soong2009">{{cite journal | vauthors = Soong D, Einarson A | title = Vaginal yeast infections during pregnancy | journal = Canadian Family Physician | volume = 55 | issue = 3 | pages = 255–6 | date = March 2009 | pmid = 19282531 | pmc = 2654841 }}</ref>

For vaginal yeast infections, many complementary treatments are proposed, however a number have side effects.<ref name=":0">{{cite journal | vauthors = Felix TC, de Brito Röder DV, Dos Santos Pedroso R | title = Alternative and complementary therapies for vulvovaginal candidiasis | journal = Folia Microbiologica | volume = 64 | issue = 2 | pages = 133–141 | date = March 2019 | pmid = 30269301 | doi = 10.1007/s12223-018-0652-x | s2cid = 52889140 }}</ref> No benefit from probiotics has been found for active infections.<ref name=Ab2009/>

=== Blood-borne infection ===
{{main|Fungemia}}
[[Candidemia]] occurs when any Candida species infects the blood. Its treatment typically consists of oral or [[intravenous]] antifungal medications.<ref name=NIHSystemic>{{cite web |title=Systemic candidiasis |url=http://rarediseases.info.nih.gov/gard/1076/systemic-candidiasis/resources/1 |website=NIH.gov |publisher=U.S. DHHS, National Institute of Health |date=Oct 2014 |access-date=April 19, 2015 |url-status=live |archive-url=https://web.archive.org/web/20150427111120/http://rarediseases.info.nih.gov/gard/1076/systemic-candidiasis/resources/1 |archive-date=April 27, 2015 }}</ref> Examples include intravenous [[fluconazole]] or an [[echinocandin]] such as [[caspofungin]] may be used.<ref name=IDSA2016 /> [[Amphotericin B]] is another option.<ref name=IDSA2016 />