# Balanitis (Acute Candidal & Bacterial) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: BASHH UK National Guideline for the Management of Balanoposthitis 2018 · Egyptian National Drug Formulary - Antimicrobial 2023 (fluconazole monograph) - Verified date: 2026-08 ## Verified against - BASHH UK National Guideline for the Management of Balanoposthitis 2018 - Egyptian National Drug Formulary - Antimicrobial 2023 (fluconazole monograph) ## Treatment metadata - Clotrimazole — topical - Nystatin — topical - Fluconazole — 150 mg — oral.solid - Mupirocin — topical - Amoxicillin + Clavulanic acid — 1000 mg — oral.solid - Cefalexin — 500 mg — oral.solid - Hydrocortisone — topical ## Complete treatment card ```text BALANITIS (ACUTE CANDIDAL & BACTERIAL) Sources: BASHH UK National Guideline for the Management of Balanoposthitis 2018 · Egyptian National Drug Formulary - Antimicrobial 2023 (fluconazole monograph) Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Itching, tenderness, burning, or discomfort at the tip of the penis is typical [itching] - Soreness, swelling, sores, or pain on urination may be reported - Symptoms commonly flare up after sex - Trouble pulling back the foreskin, or pain when trying to, is a frequent complaint - A foul odor, plaques, or the foreskin ballooning during urination point to phimosis [plaques] SIGNS - what you find (6) - A red, inflamed glans on exam is essentially diagnostic by itself - Small bumps with patchy redness and a glossy, taut-looking glans can be seen [redness] - The glans is often tender to touch and smegma is commonly present, sometimes infected - A curd-like white coating with discharge points toward a yeast infection - Nearby groin lymph nodes can be enlarged - A ring-shaped rash on the glans together with joint inflammation and mouth sores suggests reactive arthritis [mouth ulcers · rash] TESTS (7) - Visual inspection alone is usually enough to make the diagnosis - Any discharge present should be sent for culture - A potassium hydroxide preparation can pick up Candida - STI screening covers blood work for syphilis, HIV, and HPV, plus a diabetes check - Dermoscopy can help tell ordinary inflammation apart from a premalignant or malignant lesion - Not improving after 4 weeks of standard treatment, or fast growth despite it, raises concern for penile cancer - Biopsy, excision, or ablation is done when dermoscopy is unavailable or does not give a clear answer IF NOT THIS - what else fits (9) - Balanoposthitis (inflammation extending to the foreskin) - Atopic dermatitis, with dryness, itching, and swelling of the glans - Contact dermatitis from an irritant or allergen - Eczema, causing itchy, cracked, dry skin - Lichen planus, with small itchy pink or purple spots - Lichen sclerosus (balanitis xerotica obliterans), an autoimmune whitish, scarring skin disorder - Psoriasis, a scaly skin disorder that can also involve the glans - Penile intraepithelial neoplasia, a precancerous change of the glans skin - Squamous cell carcinoma of the penis, which can look like ordinary balanitis Source StatPearls "Balanitis" - disease-level clinical article Status traced to the source above Rx: Topical antifungal | Main treatment | Secondary bacterial infection - topical | Secondary bacterial infection - oral TOPICAL ANTIFUNGAL - choose one 1. CLOTRIMAZOLE [1st line] Adult Apply thin layer of 1% cream to glans penis and inner prepuce twice daily x 7-14 days Peds Apply thin layer twice daily for 7-14 days for candidal balanitis Choice Alternatives. Clotrimazole leads: the source names topical imidazoles, clotrimazole 1% and miconazole 2%, as the preferred first-line therapy, and gives nystatin only as the alternative for a patient allergic to imidazoles. Neither treats a bacterial infection. Source BASHH UK National Guideline for the Management of Balanoposthitis 2018 Why Topical imidazole antifungal that disrupts the fungal cell membrane, treating the Candida overgrowth responsible for most balanitis; first-line for the candidal form. Caution Candidal balanitis is the most frequent cause; screen for underlying Type 2 Diabetes Mellitus in recurrent cases. Advise hygiene: wash glans gently daily with warm water alone, dry thoroughly, avoid scented soaps. Treat female sexual partner if symptomatic for vulvovaginal candidiasis. Egypt CANEMAZOLE 1% CREAM 20 GM UP PHARMA 5.00 EGP CANDISTAN 1% TOPICAL CREAM 15 GM KAHIRA > ARAB... 7.25 EGP DERMATIN 1% TOP. CREAM 14 GM PHARCO 15.00 EGP CANESTEN 1% CREAM 20 GM MEMPHIS > BAY... 29.00 EGP LOCASTEN 1% CREAM 20 GM ALEXANDRIA 29.00 EGP CANDISTAN 1% TOPICAL CREAM 40 GM KAHIRA > ARAB... 36.00 EGP 2. NYSTATIN [1st line] Adult Apply to the affected area twice daily - Until healing is complete Peds Apply to the affected area twice daily, the same as for an adult - the formulary states no weight-based topical dose. Source Balanitis - StatPearls - NCBI Bookshelf (NBK537143) - disease-level clinical article (balanitis-full.txt) for the indication - verbatim: "Nystatin cream is an alternative for patients allergic to imidazoles." Dose from Egyptian National Drug Formulary - Antimicrobial 2023, nystatin monograph - verbatim, topical indication: "Fungal infections (cutaneous and mucocutaneous): Treatment of cutaneous and mucocutaneous fungal infections caused by Candida albicans and other susceptible Candida species", and dosing: "Cream, ointment: Apply to the affected areas twice daily or as indicated until healing is complete". Why The antifungal for a man who cannot take an imidazole. Clotrimazole and miconazole are both imidazoles, so an allergy to one rules out both of the usual first-line creams. Nystatin is a different class, and is the source's named alternative. Caution Only for candidal balanitis. Nystatin has no antibacterial activity, so it does nothing for a secondary bacterial infection. Ask for the plain nystatin cream. Most nystatin creams sold in Egypt combine it with neomycin and triamcinolone, and a steroid-antibiotic combination is a different medicine from the one prescribed here. Egypt NOCANDIDA 10 M.I.U. CREAM 20 GM PHAROPHARMA 4.25 EGP MAIN TREATMENT 3. FLUCONAZOLE [2nd line] Adult 150 mg single oral dose for severe or recurrent candidal balanitis - single dose Peds Specialist pediatric use only Source Egyptian National Drug Formulary - Antimicrobial 2023 (fluconazole monograph) Why Oral triazole antifungal used when topical antifungal treatment fails or is poorly tolerated in severe or recurrent candidal balanitis. Caution Fluconazole is an oral option when topical therapy fails or is poorly tolerated. Check for CYP3A4 drug interactions. Egypt JENFUNGA 150 MG 1 CAPS. EGPI > JENIKO... 4.50 EGP (4.50/unit) AMRIFLUCAN 150 MG 2 CAPS. AMRIYA 11.00 EGP (5.50/unit) FLUDCONRIZOLE 150 MG 1 CAPS. RIVA PHARMA S... 6.00 EGP (6.00/unit) FLUCORAL 150 MG 4 CAPS. SEDICO 60.00 EGP (15.00/unit) TRICONAL 150 MG 1 CAPS. T3A PHARMA > ... 26.50 EGP (26.50/unit) NAVILUCA 150 MG 2 CAPS. INTERNATIONAL... 69.00 EGP (34.50/unit) NAZOWELL 150 MG 3 CAPS. EGPI > HEALTH... 108.00 EGP (36.00/unit) DIFLUCAN 150 MG 1 CAPS. PFIZER 111.00 EGP (111.00/unit) DIFLUNAZOLE 25MG/5ML SYRUP 70ML CID 28.80 EGP -> ? strength differs, ? different route - not oral solid FLUCAZONIL 25MG/5ML SYRUP 70 ML EL NILE. 28.80 EGP -> ? strength differs, ? different route - not oral solid 4. HYDROCORTISONE [add-on - not a substitute] Adult Apply thin layer of 1% cream twice daily for up to 7 days as anti-inflammatory adjunct for marked erythema and itching x up to 7 days Peds Apply thin layer twice daily for up to 5-7 days under medical advice Source BASHH UK National Guideline for the Management of Balanoposthitis 2018 Why Low-potency topical corticosteroid added to the antifungal to calm marked erythema and itching; used alongside the antifungal, never as monotherapy, since a steroid alone would let an active fungal infection worsen. Caution Co-administer with topical antifungal; avoid steroid monotherapy in active fungal infection. Avoid prolonged application to delicate penile skin. Egypt NOVACORTIN 1% CREAM 15 GM PHAROPHARMA 4.75 EGP NOVACORTIN 1% OINT. 15 GM PHAROPHARMA 4.75 EGP MICORT 1% CREAM 20 GM MISR 12.50 EGP HYDROCORTISONE 1% OINT. 20 GM MISR 21.00 EGP SECONDARY BACTERIAL INFECTION - TOPICAL 5. MUPIROCIN [2nd line] Adult Apply 2% cream or ointment three times daily x 7 to 14 days Peds Applied the same way in children - a topical dose is not weight-based. Source Balanitis - StatPearls - NCBI Bookshelf (NBK537143) - disease-level clinical article (balanitis-full.txt) - verbatim: "Treatment with an oral antibiotic (dicloxacillin 500 mg or cephalexin QID × 7 days) and mupirocin topical cream applied TID for 7 to 14 days is appropriate if there is a concern for concomitant cellulitis or a secondary infection." The 2% strength is the only mupirocin marketed in Egypt. Why Topical antibacterial cover where the glans looks secondarily infected rather than simply inflamed. The source pairs it with an oral antibiotic when cellulitis is a concern, not instead of one. Caution The source pairs this with an oral antibiotic where there is concern about cellulitis. Topical treatment alone does not cover a spreading infection. Reassess if there is no improvement. Failure of first-line treatment should raise the question of a second infection or an underlying malignancy, which needs a culture and a biopsy. Egypt BACTROFORM 2% TOP. OINT. 15 GM WESTERN PHARM... 35.00 EGP MUPIROCIN SAJA 2% TOP. OINT. 15 GM BIOPHARM EGYPT > SAJA PHARMA 35.00 EGP MUPIRAX 2% OINT. 10 GM GLOBAL NAPI P... 48.00 EGP MUPIROCIN SAJA 2% TOP. OINT. 20 GM BIOPHARM EGYPT > SAJA PHARMA 83.00 EGP MUPIRAX 2% OINT. 30 GM GLOBAL NAPI P... 118.00 EGP SECONDARY BACTERIAL INFECTION - ORAL - choose one 6. AMOXICILLIN + CLAVULANIC ACID [2nd line] Adult 875/125 mg orally every 12 hours x 5 to 7 days Peds No weight-based dose here: the formulary sets paediatric co-amoxiclav by indication and states none for this one. Use cefalexin below for a child, which carries the formulary's general paediatric dose. Choice Alternatives, both for secondary bacterial infection or concomitant cellulitis - not for uncomplicated candidal balanitis, which needs the topical antifungal above and no antibiotic at all. Co-amoxiclav is put first on dosing practicality: twice a day against cefalexin's four times a day, for the same 7-day course. Cefalexin is the one to use in a child: it is the one of the two carrying a weight-based paediatric dose. Source Balanitis - StatPearls - NCBI Bookshelf (NBK537143) - disease-level clinical article (balanitis-full.txt) for the indication - verbatim: "Anaerobic infections can be treated with metronidazole, whereas aerobic infections may be treated with oral cephalosporins, erythromycin, or amoxicillin/clavulanic acid." Dose from Egyptian National Drug Formulary - Antimicrobial 2023, amoxicillin and clavulanic acid monograph - verbatim indication "Skin and skin structure infections", and dosing: "Immediate release: 500 mg every 8 to 12 hours or 875 mg every 12 hours" with "Duration: 5 to 7 days for mild to moderate infection and 10 days for severe infection". Why Oral cover for the aerobic bacterial balanoposthitis the card's title claims and never treated. Twice-daily dosing matters for a 7-day course in a well outpatient. Caution Not for uncomplicated candidal balanitis. An antibiotic is for secondary bacterial infection or cellulitis, and giving one for simple candidal inflammation makes the candida worse. Ask about penicillin allergy before this one. Cefalexin is also a beta-lactam and is not the answer to a severe or immediate penicillin reaction. Reassess if there is no improvement. Failure of first-line treatment should raise the question of a second infection or an underlying malignancy, which needs a culture and a biopsy. Look for the diabetes. Recurrent or intractable balanoposthitis in an adult man is a reason to check the blood sugar. Egypt E-MOXCLAV 1G 10 F.C. TAB. EIPICO 14.00 EGP (1.40/unit) JULMENTIN 2X 1GM 15 TAB. JULPHAR 57.50 EGP (3.83/unit) DEXICLAVE 1 GM 10 F.C. TABS. RAMEDA > NOVE... 38.50 EGP (3.85/unit) MACLAVEX 1 GM 14 F.C.TABS. MASH PREMIERE 105.00 EGP (7.50/unit) CLAVIMOX 1 GM 12 F.C.TABS. PHARCO 130.00 EGP (10.83/unit) MEGAMOX 1 GM 14 F.C. TABS. AL JAZEERA PH... 178.00 EGP (12.71/unit) CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS. RAMEDA > ORGANOPHARMA 106.00 EGP AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETS GLAXO SMITHKLINE 169.00 EGP LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML MISR > AL ROWAD PHARMACEUTICAL... 8.00 EGP -> ? strength differs, ? different route - not oral solid MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML CID 8.00 EGP -> ? strength differs, ? different route - not oral solid 7. CEFALEXIN [2nd line] Adult 500 mg orally every 6 hours x 7 days Peds 25-50 mg/kg/day [child max 2000 mg] (25 to 50 mg/kg/day divided every 6 or 12 hours, maximum 2,000 mg/day (Egyptian National Drug Formulary, cephalexin monograph, general dosing for mild to moderate infection).) 3kg -> 75-150 mg/day 4kg -> 100-200 mg/day 5kg -> 125-250 mg/day 6kg -> 150-300 mg/day 7kg -> 175-350 mg/day 8kg -> 200-400 mg/day 9kg -> 225-450 mg/day 10kg -> 250-500 mg/day 11kg -> 275-550 mg/day 12kg -> 300-600 mg/day 13kg -> 325-650 mg/day 14kg -> 350-700 mg/day 15kg -> 375-750 mg/day 16kg -> 400-800 mg/day 17kg -> 425-850 mg/day 18kg -> 450-900 mg/day 19kg -> 475-950 mg/day 20kg -> 500-1000 mg/day 21kg -> 525-1050 mg/day 22kg -> 550-1100 mg/day 23kg -> 575-1150 mg/day 24kg -> 600-1200 mg/day 25kg -> 625-1250 mg/day 26kg -> 650-1300 mg/day 27kg -> 675-1350 mg/day 28kg -> 700-1400 mg/day 29kg -> 725-1450 mg/day 30kg -> 750-1500 mg/day 31kg -> 775-1550 mg/day 32kg -> 800-1600 mg/day 33kg -> 825-1650 mg/day 34kg -> 850-1700 mg/day 35kg -> 875-1750 mg/day 36kg -> 900-1800 mg/day 37kg -> 925-1850 mg/day 38kg -> 950-1900 mg/day 39kg -> 975-1950 mg/day 40kg -> 1000-2000 mg/day 41kg -> 1025-2000 mg/day (upper capped) 42kg -> 1050-2000 mg/day (upper capped) 43kg -> 1075-2000 mg/day (upper capped) 44kg -> 1100-2000 mg/day (upper capped) 45kg -> 1125-2000 mg/day (upper capped) 46kg -> 1150-2000 mg/day (upper capped) 47kg -> 1175-2000 mg/day (upper capped) 48kg -> 1200-2000 mg/day (upper capped) 49kg -> 1225-2000 mg/day (upper capped) 50kg -> 1250-2000 mg/day (upper capped) Source Balanitis - StatPearls - NCBI Bookshelf (NBK537143) - disease-level clinical article (balanitis-full.txt) for the indication and the frequency and duration - verbatim: "Treatment with an oral antibiotic (dicloxacillin 500 mg or cephalexin QID × 7 days) and mupirocin topical cream applied TID for 7 to 14 days is appropriate if there is a concern for concomitant cellulitis or a secondary infection." The article gives no strength for cephalexin - the 500 mg is from Egyptian National Drug Formulary - Antimicrobial 2023, cephalexin monograph - verbatim indication "Skin and skin structure infections: Treatment of skin and skin structure infections caused by S. aureus and/or S. pyogenes", and dosing: "Usual adult dosage range: Oral: 250 to 1,000 mg every 6 hours or 500 mg every 12 hours (maximum: 4 g/day)". QID is every 6 hours, so 500 mg every 6 hours sits inside the formulary range at the article's frequency. Why The cephalosporin option, and the one to use in a child - its paediatric dose is the formulary's general figure for mild to moderate infection. Caution Four times a day. A missed dose matters more on a 6-hourly antibiotic than on a twice- daily one - say so when handing it over. Not for uncomplicated candidal balanitis. An antibiotic is for secondary bacterial infection or cellulitis. Tablets and oral suspension are not bioequivalent and must not be swapped milligram for milligram - Egyptian National Drug Formulary, cephalexin monograph. Avoid after a severe or immediate reaction to a penicillin. Egypt CEFLODIX 500 MG 12 CAPS. ARAB CAPS > P... 9.00 EGP (0.75/unit) CEPHALEXCID 500 MG 12 CAPS. CID 10.30 EGP (0.86/unit) CEPHOXIN 500MG 12 TAB. PHARCO B 10.50 EGP (0.88/unit) CEPHALEXIN 500MG 10 CAPS. ARAB DRUG COM... 10.10 EGP (1.01/unit) MEDICEFLEXIN 500 MG 20 CAPS. T3A PHARMA > ... 25.25 EGP (1.26/unit) CEPHALEXIN 500MG 12 CAPS B.P.2007 SHIFA MEDICAL PRODUCTS > O... 27.00 EGP (2.25/unit) KEFLEX 500 MG 12 CAPS. HIKMA PHARMA 58.00 EGP (4.83/unit) CEPOREX 500MG 12 TABS. GLAXO SMITHKLINE 69.00 EGP (5.75/unit) AMTHROST 125MG/5ML SUSP. 60ML SIGMA > SABAA 4.00 EGP -> ? strength differs, ? different route - not oral solid AMTHROST 250MG/5ML SUSP. 60ML SIGMA > SABAA 4.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)