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Candida & Yeast Infection Treatment - Rotating and Combining Antifungals

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Selection of anti-fungal substances for Candida rotation therapyWhen it comes to what is variously known as intestinal yeast overgrowth, fungal-type dysbiosis, gut fermentation syndrome, or simply Candida, it is safe to say that prevention is much simpler than cure. Ignored by the conventional medical establishment, people affected by this condition often struggle to treat themselves to alleviate their many symptoms which can range from fatigue, muscle aches and pains, and general malaise to cognitive symptoms such as poor concentration and memory, and mood disturbances including depression, anxiety, irritability, restlessness, and mood swings. Most of these symptoms are likely the result of the chronic absorption of toxins produced by Candida (or whatever fungal organism is the problem),  primarily ethanol and acetaldehyde, and the consequences these substances have on metabolic functions.

For more information see:

Candida and Gut Dysbiosis 

My Candida Hell - Chronic Ethanol and Acetaldehyde Poisoning


To avoid developing this awful condition in the first place measures must be taken from before a baby is born. The gut microflora of a child is inherited from its mother so it is essential that the mother's own microflora is as healthy as possible. Things to avoid include unneccesary antibiotics (particularly broad spectrum types), the contraceptive pill, and drugs which suppress the immune system such as steroids, along with a high sugar diet. Things which can be beneficial include yogurt and foods containing probiotic bacteria such as kefir, probiotic supplements, and prebiotic foods and supplements. Prebiotics are special sugars which feed the probiotic bacteria in the gut. Foods high in prebiotics include onions, garlic, chicory, asparagus, and artichoke. Prebiotic supplements usually contain fructooligosaccharides (FOS) and/or inulin. It is important that infants are breastfed for a significant amount of time (at least 4-6 months) as breast milk contains prebiotics and other substances which encourage the growth of beneficial bacteria and ensure the child develops a healthy gut microflora and immune system.


Rotating or Combining Antifungals?  

Should you or someone close to you be unlucky enough to suffer from Candida information about how to treat it can be confusing and contradictory. A lot of this is because the condition is not yet accepted by conventional medicine so research is limited. However, research based on Candida and fungal infections that are accepted (such as those associated with AIDS and other immunocompromised patients) can point us in the right direction.

Candida and other yeast/fungal organisms that cause disease in humans are very efficient at evading drugs used to kill them. They quickly develop mechanisms to defend themselves. One research paper published in the Lancet (Sanglard & Odds 2002) explains that Candida species achieve this via "expression of efflux pumps that reduce drug accumulation, alteration of the structure or concentration of antifungal target proteins, and alteration of membrane sterol composition." Essentially what this means is that Candida cells pump the drugs back out of themselves, and alter the structure of proteins and cell membranes which the drugs target, so they no longer work.

The rotational approach has been championed by natural healers such as David B. Schlesinger, L.Ac of modernherbalist.com and Dr. Michael Biamonte. The idea is that by using typically 4 different natural antifungal remedies one at a time for 4 days before switching to the next, and so forth, the Candida does not have time to adapt and develop resistance.

Modernherbalist.com has this to say on the subject:

"The reason that clearing such organisms from the system can be so difficult, is the inherent ability of most parasitic organisms (including Candida albicans) to adapt to exposure to almost any potential poison that they come in contact with, by means of a mutation process.

The utilization of a rotatational method of administration of the antifungals undermines these organisms' adaptive survival mechanisms. They simply cannot mutate rapidly enough to keep up with the constantly changing array of antifungals that they're being exposed to."

While all of this certainly makes sense, and judging by the chatter on internet forums is effective for many people, I cannot find much science to back it up.

The other alternative is to combine antifungals and use more than one at the same time. Research has shown that certain antifungal agents used together can have synergistic effects - this means the overall Candida/yeast fighting activity is even greater than if you added their individual activity together.

For example, a recent study found that the common antifungal drug nystatin and oregano oil worked synergistically to give a much more powerful antifungal effect than either alone (Rosato et al 2009). Given that both nystatin and oregano are widely available (nystatin by prescription) and relatively cheap, this could make for a very attractive Candida treatment approach backed by scientific study. It seems likely that Candida and other yeast would be unable to adapt to concurrent attack by different antifungals that use different mechanisms to kill the organism.

I will let you do your own research now but I hope I have given you a good primer and a good idea of what to look for...

To find medical studies I find the easiest online tool to use is Google Scholar.


Candida & Yeast Infection Treatment - Rotating and Combining AntifungalsDynamic Neural Retraining Program (DNRS)


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  • Guest - Ash

    If 1)Nystatin and oregano oil,2)diflucan and caprylic acid,3)grape seed extract and clove oil rotating this combination for synergytic effect is it gives resistance? They can effectively over come mutation

  • Guest - Olivia_R

    Hi Maff,

    First of all, I must say this post is the most useful resource I have ever come across on this topic. Thank you so much! :)
    I'm going to try Nystatin the next week, luckily I have a relative who is a doctor and he is willing to prescribe this medication for me, he is just not well-informed about this illness so he cannot give me any advice but he offers any help he can.

    As far as I have read your blog posts and comments, it seems to me that you still ould not beat this illnes, is that correct?
    Have you tried Nystatin? What can I expect if I'm going to take it? Only decreasing the sympthoms? I had taken Fluconazole for a long time but it couldn't wipe out this candida colony in me... If you have tried Nystatin, what is your experience, is it better that other medicines? How many pills a day did you take?
    Sorry for the many questions and thanks for your reply in advance. :)


  • England, UK

    Hi Benchua. I would need to have another look at the current research to answer that question accurately (and more importantly, safely). It's been a little while since I looked into this but I suspect the researchers conducting the study I was commenting on had patients take anti-fungals 'A' and 'B' together. It would be easier to eliminate chance being the reason for their results that way, thus showing there was actually a synergistic mechanism involved. As I said however, I wouldn't like to say anything for sure without doing an up-to-date review of the literature. I will try my best to get back to you on this as it's certainly a therapeutic approach worth exploring.

  • Guest - BENCHUA


    I would like to clarify some questions with you:)

    You once mentioned this to me "Research has shown that certain antifungal agents used at the same time can have synergistic effects - this means the overall Candida/yeast fighting activity is even greater than if you added their individual activity together."

    When you mean antifungal agents used at the same time do you mean taking antifungal A together with antifungal B at the same second or when you mean "same time" do you mean taking Antifungal A at noon and Antifungal B at evening throughout one day?

    By doing this, does it help to prevent candida from mutating?

  • Middlesbrough, UK

    Hi Ben & Caroline,
    Great question you've both pinpointed. Ben,you're correct in stating that different anti-fungal medications have different mechanisms of action; some are more fungicidal (directly killing fungi/yeast cells) while others may be more fungistatic (inhibiting fungal/yeast cell growth), for example. Many anti-fungal drugs (particularly the systemics) are highly potent and may do a very good job on their own taken over a sufficient length of time. However, they can also be particularly toxic to ourselves also; hepatotoxicity is a big problem with these meds. I'm thinking out loud here but with this in mind it may make sense to rotate with safer alternatives to avoid side-effects. Nystatin for example is not absorbed systemically so taken orally it only acts against fungal infections in the gut. In summary, my personal opinion is that rotating is less necessary when using anti-fungal medications as hopefully the fungal overgrowth will be eradicated before resistance becomes a factor. Whichever route you choose I would be negligent not to add that you should work with a doctor or qualified nutritionist/herbalist due to the inherent risk of drug-nutrient-herb interactions with this approach.

  • Guest - Ben


    Could I clarify with one more question. If I were to replace the natural antifungals to chemically manufactured antifungals like nystatin can I use this method of using Antifungals A,B,C,D on days 1,2,3,4 respectively and repeat to prevent candida from being resistant? The antifungals must also work differently in killing candida right?

  • Guest - Caroline

    May I ask If I decide to use chemically manufactured antifungals instead of natural antifungals, do I have to get from the doctor 4 different types of antifungals which work differently to kill the candida yeast? For instance using antifungal A,B,C,D on days 1,2,3,4 respectively and repeat. Will this help in preventing candida from becoming resistsnt and work the same way as when I switched those chemically produced antifungals to natural antifungals?

  • Middlesbrough, UK

    Hi Benjamin,
    That's correct, simply take anti-fungals A,B,C,D on days 1,2,3,4 and repeat. It's logical to use a variety of agents that act in different ways against yeast/fungal cells e.g. caprylic acid + oregano oil + grapfruit seed extract (GSE) + garlic extract. For best results it's a good idea to have a CDSA / gut ecology profile test done (stool sample) as these provide information on the sensitivity of your particular problem gut microbes to a variety of pharmaceutical and natural anti-fungal agents; you can therefore select a few of the most potent to rotate,
    Hope this helps.

  • Guest - Benjaminchua

    Hi can I clarify with you what do you mean when you stated this "typically using 4 different antifungals one at a time for 4 days before switching to the next and so forth"
    Do you mean to take for instance antifungal A ,B,C,D on day 1,2,3,4 respectively and repeat?:)

  • Hi, I am from Roanoke VA, looking for people in my area for support. I struggle with systemic candida and treatment is very hard on my body, I developed many chemical sensitivities, I am new to all this and need ideas and support.
    Thank you

    Comment last edited on about 8 years ago by Maff

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