| Acute regimens | Metronidazole (Flagyl), 500 mg orally twice daily for seven days* | Topical antifungal agents† (see Table 6) Fluconazole (Diflucan), 150 mg orally one time | Metronidazole, 2 g orally in a single dose‡ |
| Clindamycin phosphate vaginal cream 2 percent (Cleocin Vaginal), one full applicator (5 g) intravaginally each night for 7 days* (Note that oil-based cream may weaken condoms and diaphragms.) |
| Metronidazole gel 0.75 percent (Metrogel-Vaginal), one full applicator (5 g) intravaginally twice daily for 5 days* |
| Alternative regimens | Metronidazole, 2 g orally in a single dose Clindamycin (Cleocin), 300 mg orally twice daily for 7 days | Boric acid powder in size-0 gelatin capsules intravaginally once or twice daily for 2 weeks§ | Metronidazole, 500 mg orally twice daily for 7 days |
| Pregnancy | Metronidazole, 250 mg orally three times daily for 7 days (recommended regimen)∥ | Only topical azole agents intravaginally for 7 to 10 days | Metronidazole, 2 g orally in a single dose (usually not recommended in first trimester) |
| Alternative regimens for pregnancy | Metronidazole, 2 g orally in a single dose∥ Clindamycin, 300 mg orally twice daily for 7 days∥ |
| Metronidazole gel 0.75 percent, one full applicator (5 g) intravaginally twice daily for 5 days (acceptable only in women who have not had a previous premature delivery) |
| Recurrence¶ | Retreat with an alternative regimen. | For four or more episodes of symptomatic vulvovaginal candidiasis annually: initial acute intravaginal regimen for 10 to 14 days followed immediately by maintenance regimen for at least 6 months (e.g., ketoconazole [Nizoral], 100 mg orally once daily) | Metronidazole, 2 g orally once daily for 3 to 5 days (Note that treatment of sexual partners increases cure rate.) |