Which antifungal is the best choice for treating a patient with vulvovaginal candidiasis seeking a short course treatment?

The best choice for treating vulvovaginal candidiasis with a short-course regimen is oral fluconazole. This antifungal medication is highly effective against Candida species, which are the most common cause of vulvovaginal candidiasis. A single oral dose of fluconazole is usually sufficient to clear the infection, providing quick relief to the patient.

Fluconazole is absorbed well from the gastrointestinal tract and has been shown to be effective in treating yeast infections, making it a convenient option for patients who may prefer not to apply topical treatments for an extended period. The convenience of a single oral dose also aids in patient compliance, as it avoids the need for multiple applications associated with topical agents.

In contrast, topical therapies like miconazole require multiple applications over several days to achieve the desired therapeutic effect, which may not align with a patient's desire for a short course of treatment. Other options, such as terbinafine and efinaconazole, are primarily used for fungal infections of the skin and nails and are not indicated for vulvovaginal candidiasis, making them unsuitable choices for this particular condition.