Hello everyone and thanks for all the suggestions and sorry for the late update. I've been out for some times and I've been so busy since I've got back.
Here is the entire story for your entertainment 🙂
After a long conversation with the MD (this is an "old" OBGYN from the 1980's who would rather focus on delivering babies than taking care of the drug treatment), the patient ended up with Gynazole-1 (butoconazole 2%) 1 app PV hs x1 dose
-Since the pharmacy is an outpt for the women hospital next door, I could see details of her ER episode of the Diflucan reaction: only pruritic systemic rash was present, no SOB/angioedema/respiratory sx/ steve-johnson Sx at all and she confirmed it with me on the phone.
-This lady had quite a difficult pregnancy, she had HTN, gestation diabetes together with other common issues of pregnancy such as depression, back pain, constipation, N/V etc. The yeast issue was caused by a course of Amoxil given to her by her dentist.
-I came in with Terazol-7 (or -3) in mind as CDC guideline 2015 recommends 7-days topical azole treatment for vulvovaginal candidasis; backup recs were nystatin cream administered through a vaginal applicator (i.e. a stick I have in the pharmacy for other vaginal cream/gel admin) and last resort was Gynazole-1 (this is a relatively new drug on the market). I was lucky to have my partner come in and cover the first half of that day so I could be free on the phone talking. After talking to the MD; I ended up doing Gynazole-1
+The patient stated that she was very tired of meds (and I totally empathized as her profile was full of PNV, diabetic meds, N/v meds, all three approved HTN meds for pregnancy, etc.) and just wanted something quick and fast and preferentially NOT over a week period. Also, she used OTC monistat-1 OTC during her last pregnancy and she was fine with it
+Gynazole-1 is new (category C pregnancy), systemic absorption is 1.7% which is quite low; she was in 2nd trimester; this product is only 1 time dosing and cure rate is comparable (if not a bit higher) than other peers in the class
-F/U 1 week later, she was fine and the yeast issue was completely gone: everyone was happy
-I saw some comments about herbal tx, to my limited knowledge tea tree oils, yogurt (porobiotics), garlic, etc. only have anecdotal evidence for cure rate and do not have enough clinical evidence for good cure rate for me to recommend. Also, terbinafine does not have an official FDA indication for vulvovaginal candiasis and off-label usage for such indication requires a long course of tx (i.e. weeks) which I don't think would be preferred in this patient.
