Clotrimazole and fluconazole are licensed for OTC sale. Clotrimazole, as vaginal cream and pessaries, is applied locally, preferably at night. Fluconazole is taken orally, as a single dose at any time of day.

Burning and irritation may occur with topical imidazoles, and contact dermatitis has been reported, but amounts absorbed during short courses are thought insufficient to cause adverse systemic effects.

Adverse effects with oral fluconazole are mainly gastrointestinal, including abdominal pain, diarrhoea, nausea and vomiting and flatulence. Teratogenicity has occurred with high doses of fluconazole in animals, and the drug is excreted in breast milk.

The licensing conditions for non-prescription azoles prohibit their use in pregnant and breastfeeding women. Fluconazole should also be used with caution in patients with impaired renal or hepatic function.

In order to minimise any risk of effects or inappropriate use, azoles should be supplied only to women who have had the condition diagnosed previously by a doctor. They should not be supplied to women who have had more than two attacks in the previous six months, as this could indicate an underlying cause, such as diabetes, that requires investigation.

A recent study found local clotrimazole and oral fluconazole to be equally effective in the treatment of vaginal candidiasis, with a cure rate of around 90 per cent, seven days after treatment.⁷