Minor ailments

Vulvovaginal candidiasis (yeast infection)

Clinical basis & sources

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Allowable drugs under Schedule 4 (4)

Drugs an Ontario pharmacist may prescribe for Vulvovaginal candidiasis (yeast infection) under O. Reg. 256/24, Schedule 4. Choice still depends on the assessment, contraindications, allergies, and product availability — this is the eligible list, not a recommendation.

  • Clotrimazole
  • Fluconazole
  • Miconazole
  • Terconazole

Symptoms this assessment screens

  • Vulvar or vaginal itching, soreness, burning, redness, or swelling
  • Thick white or curdy discharge without strong fishy odour
  • External dysuria or discomfort with intercourse is consistent with vulvar irritation
  • Sporadic or infrequent episode with mild to moderate symptoms
  • Patient is not pregnant and pregnancy is not possible or is confidently excluded
  • Medication safety screen completed for azole interactions, allergy, liver disease, QT risk, and latex-device counselling

Red flags — any positive means refer

  • Pregnant, possibly pregnant, breastfeeding with uncertainty, age under 12, or first episode in a child/adolescent requiring diagnostic assessment
  • Pelvic/lower abdominal pain, fever, abnormal bleeding, malodorous/fishy discharge, green/yellow/frothy discharge, genital ulcers/lesions, sexually transmitted infection exposure, or sexual assault concern
  • Severe vulvar swelling, extensive fissures/excoriations, intense pain, immunocompromise, poorly controlled diabetes, or systemic illness
  • Four or more episodes in 12 months, symptoms persisting after treatment, recent failed azole therapy, or suspected non-albicans Candida
  • Symptoms are atypical, diagnosis is uncertain, urinary symptoms suggest UTI, or patient requests repeated empiric treatment without confirmation
  • Azole allergy, clinically significant fluconazole interaction, serious liver disease, QT-risk concern, or another safety issue that cannot be managed

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