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    Therapy may be instituted before the results of the cultures and other laboratory studies are known; however, once these results become available, anti-infective therapy should be adjusted accordingly. Fluconazole is not recommended for use in children and adolescents under the age of 16 years, unless antifungal treatment is imperative, and no suitable alternative agent exists, due to insufficient safety and efficacy (see section 5.2). Coadministration of terfenadine is contraindicated in patients receiving Fluconazole 150mg capsule at multiple doses of 400 mg per day or higher based upon results of a multiple dose interaction study. Coadministration of other medicinal products known to prolong the QT interval and which are metabolised via the cytochrome P450 (CYP) 3A4 such as cisapride, astemizole, pimozide, quinidine and erythromycin are contraindicated in patients receiving fluconazole (see sections 4.4 and 4.5). Fluconazole 150 mg capsule has been associated with rare cases of serious hepatic toxicity including fatalities, primarily in patients with serious underlying medical conditions. In cases of fluconazole-associated hepatotoxicity, no obvious relationship to total daily dose, duration of therapy, sex or age of patient has been observed. Fluconazole hepatotoxicity has usually been reversible on discontinuation of therapy. So you think you have a yeast infection and you buy an over-the-counter (OTC) treatment, but four days later you are still very itchy/irritated/burning like crazy. First of all you need this background information: If you were right then there is a 85-90% chance that you should be better. The next step, for most women, is to call their GYNO and ask for fluconazole, known by many under the brand name Diflucan, or to retreat with a OTC topical. If you guessed correctly and aren’t better more of the same (i.e. trying fluconazole/Diflucan or another OTC medication) is not likely to be any better because the oral and topicals work in the same way. If you are not feeling better after treatment (which will happen 75% of the time just looking at the statistics) there are five possible scenarios: Put another way, if 100 women use OTC medication for vaginal yeast, 70 will have persistent symptoms because they never had yeast to begin with and 5 will still have persistent symptoms related to yeast. That means if you have persistent symptoms there is a 93% chance you never had yeast and a 7% chance that you did, but need further information to treat. The chance that more of the same will help is very slim. Other clinical pearls: A bad yeast infection can take seven days to feel a lot better, An antihistamine, like Zyrtec or Claritin, will help you feel better faster and a low dose topical steroid on the vulva (labia and vaginal opening) will also help if there is a lot of external irritation But the OTC always fails for me and the Diflucan always works! This is unlikely related to the type of medication (OTC vs prescription) and more a mechanical issue – some women place the vaginal medication too low in their vagina (if the tissues are really inflamed it can be harder to get high enough).

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