This is another very common problem
you will find in the pharmacy, and has appeared in past papers of
the pre-registration RPSGB exam various times. Understanding the
legal restrictions on the sale of OTC medicines (clotrimazole and
fluconazole), and knowledge on when to refer is important. Remember
when there is a legal restriction on the sale of an OTC medication
this is a sign to refer i.e Clotrimazole is only licensed in the UK
for OTC (over the counter) sale for over 16 years old, if the
patient is 15 years old then you need to refer to a medical
practitioner. Just because it is unlicensed for sale OTC, doesn't mean
its unlicensed for a prescriber to prescribe.
Usual symptoms of thrush
itching, soreness, vaginal discharge (odourless), trauma to
vagina area (after a recent infection or sexual intercourse)
Thrush symptoms
When to refer:
Age: Under 16 and over 60's
This is because under 16 are less likely to
have thrush and presence of thrush/vaginal candidiasis symptoms may
actually be due to something else. Over 60's are particularly
susceptible to serious infections and are therefore required to
visit the doctor if symptoms occur.
Unusual symptoms: Foul smelling discharge, pain, diarrhoea, fever,
other signs of systemic infection,
These symptoms usually indicate a bacterial
infection which has developed after the thrush infection. Remember
thrush is due to a fungal infection.
This to look out for:
Fluconazole: may interact with other medication, fluconazole is an
enzyme inhibitor (see out section on enzyme inhibitors in the
clinical section)
.
