Question

An established $34$-year-old patient presents to the gynecology clinic reporting relentless vulvovaginal pruritus and burning that has persisted for the past month. She states that a three-dose course of oral fluconazole prescribed four weeks ago provided almost no symptom relief. Her past medical history is notable for poorly controlled type 2 diabetes mellitus with a recent hemoglobin A1c of $9.2\%$. On speculum examination, the vulvar and vaginal mucosae are intensely erythematous, and there is a thick, white, clumpy discharge adherent to the vaginal sidewalls. Vaginal fluid pH is $4.2$. Microscopic evaluation of the discharge prepared with $10\%$ potassium hydroxide reveals numerous budding yeast cells, but a complete absence of pseudohyphae or true hyphae. Which of the following is the most appropriate pharmacotherapy for this patient's condition?