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Goje O, Sobel R, Nyirjesy P, Goldstein SR, Spitzer M, Faught B, Larson S, King T, Azie NE, Angulo D, Sobel JD. Oral Ibrexafungerp for Vulvovaginal Candidiasis Treatment: An Analysis of VANISH 303 and VANISH 306. J Womens Health (Larchmt) 2023; 32:178-186. [PMID: 36255448 PMCID: PMC9940793 DOI: 10.1089/jwh.2022.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Ibrexafungerp is a novel antifungal treatment for acute vulvovaginal candidiasis (VVC). Using pooled data from two phase three studies (VANISH 303 and 306) in the treatment of acute VVC, this analysis sought to determine the effectiveness of ibrexafungerp in various patient subgroups that may impact outcomes. Materials and Methods: Data from VANISH 303 (NCT03734991) and VANISH 306 (NCT03987620) evaluating ibrexafungerp 300 mg twice daily (BID) for 1 day versus placebo, were pooled and analyzed to determine clinical cure rate, clinical improvement, and mycological cure at the test-of-cure visit (day 11 ± 3) and symptom resolution at the follow-up visit (day 25 ± 4) in the overall population. Patient subgroups analyzed included race, body mass index (BMI), baseline vulvovaginal signs and symptoms (VSS) score, and Candida species. Results: At the test-of-cure visit, patients receiving ibrexafungerp, compared with those who received placebo, had significantly higher rates of clinical cure (56.9% [214/376 patients] vs. 35.7% [65/182 patients]), clinical improvement (68.4% [257/376 patients] vs. 45.1% [82/182 patients]), and mycological cure (54.0% [203/376 patients] vs. 24.2% [44/182 patients]; all p < 0.0001). At the follow-up visit, patients receiving ibrexafungerp had sustained responses with higher symptom resolution rates (66.8% [251/376 patients]) versus placebo (48.4% [88/182 patients]; p < 0.0001). Race, BMI, baseline VSS score (including VSS severity score 13-18), and Candida species infection did not adversely affect clinical cure rates. Safety analysis results were consistent with the individual studies. Conclusions: Ibrexafungerp provides a safe and well-tolerated first-in-class fungicidal, 1-day oral treatment for patients with acute VVC, the first new therapy in >20 years. Clinical Trial Registration Number: NCT03734991.
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Affiliation(s)
- Oluwatosin Goje
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ryan Sobel
- Department of Obstetrics and Gynecology, Jefferson Vulvovaginal Health Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Paul Nyirjesy
- Department of Obstetrics and Gynecology, Jefferson Vulvovaginal Health Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Steven R. Goldstein
- Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, New York, USA
| | - Mark Spitzer
- Center for Colposcopy, New Hyde Park, New York, USA.,Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Brooke Faught
- Women's Institute for Sexual Health, Division of Urology Associates, PC, Nashville, Tennessee, USA
| | - Shelagh Larson
- Department of Women and Infants, Acclaim Physician Group-Fort Worth, Fort Worth, Texas, USA
| | - Thomas King
- Department of Medical Affairs, SCYNEXIS, Inc., Jersey City, New Jersey, USA
| | - Nkechi E. Azie
- Department of Clinical Development and Medical Affairs, Wayne State University, Detroit, Michigan, USA
| | - David Angulo
- Department of Research and Development, SCYNEXIS, Inc., Jersey City, New Jersey, USA
| | - Jack D. Sobel
- Infectious Diseases, Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA.,Address correspondence to: Jack D. Sobel, MD, Wayne State University, Tolan Park Medical Building, 3901 Chrysler Service Dr, Detroit, MI 48201, USA
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Zhang L, De Salvo R, Ehret A, Young K, Trapp S. Vulvovaginal candidiasis: A real-world evidence study of the perceived benefits of Canesten ®. SAGE Open Med 2022; 10:20503121221085437. [PMID: 35371482 PMCID: PMC8969009 DOI: 10.1177/20503121221085437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/08/2022] [Indexed: 12/05/2022] Open
Abstract
Objectives: Vulvovaginal candidiasis is common in women, causing discomfort and negatively impacting quality of life. Canesten® is an established over-the-counter brand. Its clotrimazole/fluconazole-based products, available in a variety of different formulations, have demonstrated efficacy and safety in the treatment of women with thrush/vaginal yeast infection in randomized trials. This real-world evidence study, conducted in the United Kingdom and Canada, aimed to provide consumer-important information on the benefits of Canesten, collecting retrospective information from consumers about their recent experience with the product. Methods: Eligible participants were female, aged 18–60 years, and had experienced at least one episode of vaginal thrush (United Kingdom)/vaginal yeast infection (Canada) during the previous 6 months for which they had used at least one of the six Canesten products. Participants completed an online questionnaire eliciting information on the speed of onset of symptom relief, impact on quality of life, and product attributes/satisfaction. Results: Over 90% of respondents reported improvements in symptoms and quality of life after starting treatment with a Canesten product. Improvements in symptoms within 4 h of the first time of use were perceived by 42% of consumers; 76%–88% reported symptomatic relief within 1 day. The perceived general speed of onset of symptomatic relief with a Canesten oral product (1–2 days) was slightly longer than that with a Canesten topical/intra-vaginal product (⩽1 day). Most users of Canesten single (90%) and dual product treatments (95%) reported that the products started to work from the first application. Women experiencing both internal and external symptoms of thrush/vaginal yeast infection reported Canesten dual product formulations to provide faster symptomatic relief than single product treatments. Over 90% of respondents were satisfied with their use of a Canesten product. Conclusion: Canesten was found by consumers to offer rapid relief of the symptoms of thrush/vaginal yeast infection with improvements in quality of life. Consumer satisfaction was high.
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Affiliation(s)
- Lei Zhang
- Bayer Consumer Care AG, Basel, Switzerland
- Lei Zhang, Bayer Consumer Care AG, Peter Merian-Strasse 84, 4002 Basel, Switzerland.
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Lírio J, Giraldo PC, Sarmento AC, Costa APF, Cobucci RN, Saconato H, Eleutério Júnior J, Gonçalves AK. Antifungal (oral and vaginal) therapy for recurrent vulvovaginal candidiasis: a systematic review and meta-analysis. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:261-267. [PMID: 35239893 DOI: 10.1590/1806-9282.20210916] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Juliana Lírio
- Universidade Estadual de Campinas, Tocogynecolgy Postgraduate Program, Department of Obstetrics and Gynecology - Campinas (SP), Brazil
| | - Paulo César Giraldo
- Universidade Estadual de Campinas, Department of Obstetrics and Gynecology - Campinas (SP), Brazil
| | - Ayane Cristine Sarmento
- Universidade Federal do Rio Grande do Norte, Health Sciences Postgraduate Program - Natal (RN), Brazil
| | - Ana Paula Ferreira Costa
- Universidade Federal do Rio Grande do Norte, Health Sciences Postgraduate Program - Natal (RN), Brazil
| | - Ricardo Ney Cobucci
- Universidade Potiguar, Postgraduate Program in Biotechnology - Natal (RN), Brazil
| | - Humberto Saconato
- Universidade Federal de São Paulo, Department of Medicine - São Paulo (SP), Brazil
| | - José Eleutério Júnior
- Universidade Federal do Ceará, Department of Obstetrics and Gynaecology - Fortaleza (CE) Brazil
| | - Ana Katherine Gonçalves
- Universidade Federal do Rio Grande do Norte, Health Sciences Postgraduate Program - Natal (RN), Brazil.,Universidade Federal do Rio Grande do Norte, Department of Obstetrics and Gynaecology - Natal (RN), Brazil
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Cooke G, Watson C, Deckx L, Pirotta M, Smith J, van Driel ML. Treatment for recurrent vulvovaginal candidiasis (thrush). Cochrane Database Syst Rev 2022; 1:CD009151. [PMID: 35005777 PMCID: PMC8744138 DOI: 10.1002/14651858.cd009151.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Recurrent vulvovaginal candidiasis (RVVC) affects up to 5% of women. No comprehensive systematic review of treatments for RVVC has been published. OBJECTIVES The primary objective was to assess the effectiveness and safety of pharmacological and non-pharmacological treatments for RVVC. The secondary objective was to assess patient preference of treatment options. SEARCH METHODS We conducted electronic searches of bibliographic databases, including CENTRAL, MEDLINE, Embase, and CINAHL (search date 6 October 2021). We also handsearched reference lists of identified trials and contacted authors of identified trials, experts in RVVC, and manufacturers of products for vulvovaginal candidiasis. SELECTION CRITERIA We considered all published and unpublished randomised controlled trials evaluating RVVC treatments for at least six months, in women with four or more symptomatic episodes of vulvovaginal candidiasis in the past year. We excluded women with immunosuppressive disorders or taking immunosuppressant medication. We included women with diabetes mellitus and pregnant women. Diagnosis of RVVC must have been confirmed by presence of symptoms and a positive culture and/or microscopy. We included all drug and non-drug therapies and partner treatment, assessing the following primary outcomes: • number of clinical recurrences per participant per year (recurrence defined as clinical signs and positive culture/microscopy); • proportion of participants with at least one clinical recurrence during the treatment and follow-up period; and • adverse events. DATA COLLECTION AND ANALYSIS Two authors independently reviewed titles and abstracts to identify eligible trials. Duplicate data extraction was completed independently by two authors. We assessed risk of bias as described in the Cochrane Handbook for Systematic Reviews of Interventions. We used the fixed-effects model for pooling and expressed the results as risk ratio (RR) with 95% confidence intervals (CI). Where important statistical heterogeneity was present we either did not pool data (I2 > 70%) or used a random-effects model (I2 40-70%). We used the GRADE tool to assess overall certainty of the evidence for the pooled primary outcomes. MAIN RESULTS Studies: Twenty-three studies involving 2212 women aged 17 to 67 years met the inclusion criteria. Most studies excluded pregnant women and women with diabetes or immunosuppression. The predominant species found on culture at study entry was Candida albicans. Overall, the included studies were small (<100 participants). Six studies compared antifungal treatment with placebo (607 participants); four studies compared oral versus topical antifungals (543 participants); one study compared different oral antifungals (45 participants); two studies compared different dosing regimens for antifungals (100 participants); one study compared two different dosing regimens of the same topical agent (23 participants); one study compared short versus longer treatment duration (26 participants); two studies assessed the effect of partner treatment (98 participants); one study compared a complementary treatment (Lactobacillus vaginal tablets and probiotic oral tablets) with placebo (34 participants); three studies compared complementary medicine with antifungals (354 participants); two studies compared 'dermasilk' briefs with cotton briefs (130 participants); one study examined Lactobacillus vaccination versus heliotherapy versus ciclopyroxolamine (90 participants); one study compared CAM treatments to an antifungal treatment combined with CAM treatments (68 participants). We did not find any studies comparing different topical antifungals. Nine studies reported industry funding, three were funded by an independent source and eleven did not report their funding source. Risk of bias: Overall, the risk of bias was high or unclear due to insufficient blinding of allocation and participants and poor reporting. Primary outcomes: Meta-analyses comparing drug treatments (oral and topical) with placebo or no treatment showed there may be a clinically relevant reduction in clinical recurrence at 6 months (RR 0.36, 95% CI 0.21 to 0.63; number needed to treat for an additional beneficial outcome (NNTB) = 2; participants = 607; studies = 6; I² = 82%; low-certainty evidence) and 12 months (RR 0.80, 95% CI 0.72 to 0.89; NNTB = 6; participants = 585; studies = 6; I² = 21%; low-certainty evidence). No study reported on the number of clinical recurrences per participant per year. We are very uncertain whether oral drug treatment compared to topical treatment increases the risk of clinical recurrence at 6 months (RR 1.66, 95% CI 0.83 to 3.31; participants = 206; studies = 3; I² = 0%; very low-certainty evidence) and reduces the risk of clinical recurrence at 12 months (RR 0.95, 95% CI 0.71 to 1.27; participants = 206; studies = 3; I² = 10%; very low-certainty evidence). No study reported on the number of clinical recurrences per participant per year. Adverse events were scarce across both treatment and control groups in both comparisons. The reporting of adverse events varied amongst studies, was generally of very low quality and could not be pooled. Overall the adverse event rate was low for both placebo and treatment arms and ranged from less than 5% to no side effects or complications. AUTHORS' CONCLUSIONS In women with RVVC, treatment with oral or topical antifungals may reduce symptomatic clinical recurrences when compared to placebo or no treatment. We were unable to find clear differences between different treatment options (e.g. oral versus topical treatment, different doses and durations). These findings are not applicable to pregnant or immunocompromised women and women with diabetes as the studies did not include or report on them. More research is needed to determine the optimal medication, dose and frequency.
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Affiliation(s)
- Georga Cooke
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Cathy Watson
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Laura Deckx
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Marie Pirotta
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Jane Smith
- Bond University Medical Program, Faculty of Health Sciences and Medicine, Centre for Research in Evidence-Based Practice (CREBP), Gold Coast, Australia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Sharifi-Rad J, Quispe C, Rahavian A, Pereira Carneiro JN, Rocha JE, Alves Borges Leal AL, Bezerra Morais Braga MF, Melo Coutinho HD, Ansari Djafari A, Alarcón-Zapata P, Martorell M, Antika G, Tumer TB, Cruz-Martins N, Helon P, Paprocka P, Koch W, Docea AO, Calina D. Bioactive Compounds as Potential Agents for Sexually Transmitted Diseases Management: A Review to Explore Molecular Mechanisms of Action. Front Pharmacol 2021; 12:674682. [PMID: 34504422 PMCID: PMC8421529 DOI: 10.3389/fphar.2021.674682] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/12/2021] [Indexed: 12/18/2022] Open
Abstract
Sexually transmitted diseases (STDs) are produced by pathogens like bacteria, fungi, parasites, and viruses, and may generate severe health problems such as cancer, ulcers, and even problems in the newborn. This narrative review aims to present updated information about the use of natural bioactive compounds for the prevention and treatment of sexually transmitted infections. A search of the literature was performed using databases and search engines such as PubMed, Scopus, Google Scholar and Science Direct. From the pharmacotherapeutic management point of view, any strategies for prevention should contain medical approaches. The bioactive compounds obtained from natural products have shown biological effects against different microorganisms for the treatment of these diseases. The main results showed antimicrobial, antiprotozoal, antifungal and antiviral effects such as HIV. Also, the molecular mechanisms, signalling pathways and action targets of natural compounds were highlighted, thus justifying bacterial and antifungal inhibition, apoptosis or reduction of viral replication. From the data of our study, we can conclude that natural compounds may be a significant source for adjuvant drugs / complementary therapies in the treatment of STDs. With all these benefits, the future must conduct extensive clinical trials and the development of pharmaceutical nanotechnologies for a greater therapeutic effect.
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Affiliation(s)
- Javad Sharifi-Rad
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Cristina Quispe
- Facultad de Ciencias de La Salud, Universidad Arturo Prat, Iquique, Chile
| | - Amirhossein Rahavian
- Andrology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | | | | | | | | | - Anahita Ansari Djafari
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pedro Alarcón-Zapata
- Clinical Biochemistry and Immunology Department, Faculty of Pharmacy, University of Concepción, Concepción, Chile
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Concepción, Chile
| | - Miquel Martorell
- Department of Nutrition and Dietetics, Faculty of Pharmacy, and Centre for Healthy Living, University of Concepción, Concepción, Chile
- Universidad de Concepción, Unidad de Desarrollo Tecnológico, UDT, Concepción, Chile
| | - Gizem Antika
- Department of Molecular Biology and Genetics, Faculty of Arts and Science, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Tugba Boyunegmez Tumer
- Department of Molecular Biology and Genetics, Faculty of Arts and Science, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Natália Cruz-Martins
- Faculty of Medicine, University of Porto, Porto, Portugal
- Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Paweł Helon
- Branch in Sandomierz, Jan Kochanowski University of Kielce, Sandomierz, Poland
| | - Paulina Paprocka
- Department of Microbiology and Immunology, Institute of Medical Sciences, Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Wojciech Koch
- Chair and Department of Food and Nutrition, Medical University of Lublin, Lublin, Poland
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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Prevalence and Antifungal Susceptibility Profile of Clinically Relevant Candida Species in Postmenopausal Women with Diabetes. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7042490. [PMID: 33294451 PMCID: PMC7714583 DOI: 10.1155/2020/7042490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/12/2020] [Accepted: 10/25/2020] [Indexed: 12/30/2022]
Abstract
The incidence of diabetes mellitus has increased in Saudi Arabia, which has raised the risk of vulvovaginal candidiasis (VVC). This study highlights the prevalence and antifungal susceptibility of Candida species among postmenopausal women with diabetes with symptoms of VVC in Taif, a city in Saudi Arabia. Several diagnostic tools were used to differentiate the yeast isolates, including microscopic examination, culture morphology on CHROM agar, further confirmation with the VITEK 2 system, and ITS1 and ITS4 region sequencing. Antifungal susceptibility of the selected Candida species was determined using the VITEK 2 system (bioMérieux Inc., USA). Out of the 550 high vaginal swabs investigated, 86 specimens were Candida species positive (15.6%) with a significant difference according to age; the positivity in the 45–50 years' age group (12%) was higher than that in the 51–55 years' age group (3.6%). Candida albicans was the most common causative agent in 51 samples (59.3%), followed by C. glabrata in 21 samples (24.41%) and C. krusei in 14 samples (16.27%), with no significant differences between the age groups. Three isolates, including two C. albicans and one C. krusei, exhibited resistance against all the tested antifungal agents. CHROM agar and VITEK 2 were accurate phenotypic tools to identify Candida species with 100% sensitivity and specificity and were consistent with the phylogenetic characterization. The data emphasized the importance of identifying Candida species and their antifungal susceptibility among postmenopausal women with diabetes, highlighting the potential risk posed by diabetes in this age group.
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Mendling W, Atef El Shazly M, Zhang L. Clotrimazole for Vulvovaginal Candidosis: More Than 45 Years of Clinical Experience. Pharmaceuticals (Basel) 2020; 13:E274. [PMID: 32992877 PMCID: PMC7600851 DOI: 10.3390/ph13100274] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022] Open
Abstract
Vulvovaginal candidosis is a common disease, and various treatment strategies have emerged over the last few decades. Clotrimazole belongs to the drugs of choice for the treatment of vulvovaginal candidosis. Although available for almost 50 years, systematic reviews on the usefulness of topical clotrimazole across disease severity and populations affected are scarce. Thus, we conducted a systematic literature search in the PubMed and Embase databases to summarize the effectiveness and safety of topical clotrimazole in the treatment of uncomplicated (acute) and complicated vulvovaginal candidosis. In total, 37 randomized controlled studies in women suffering from vaginal yeast infections qualified for inclusion in our review. In women with uncomplicated vulvovaginal candidosis, single intravaginal doses of clotrimazole 500 mg vaginal tablets provided high cure rates and were as effective as oral azoles. A single dose of clotrimazole 500 mg was equipotent to multiple doses of lower dose strengths. Prolonged treatment regimens proved to be effective in severe and recurrent cases as well as in symptomatic pregnant women. It is therefore expected that in the general population, clotrimazole will continue to be widely used in the field of vaginal health in the upcoming years; more so as clotrimazole resistance in vaginal candidosis is rare.
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Affiliation(s)
- Werner Mendling
- German Center for Infections in Obstetrics and Gynaecology, Heusnerstrasse 40, D-42283 Wuppertal, Germany;
| | | | - Lei Zhang
- Bayer Consumer Care AG, Peter Merian-Strasse 84, CH-4002 Basel, Switzerland;
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Mochizuki T, Tsuboi R, Iozumi K, Ishizaki S, Ushigami T, Ogawa Y, Kaneko T, Kawai M, Kitami Y, Kusuhara M, Kono T, Sato T, Sato T, Shimoyama H, Takenaka M, Tanabe H, Tsuji G, Tsunemi Y, Hata Y, Harada K, Fukuda T, Matsuda T, Maruyama R. Guidelines for the management of dermatomycosis (2019). J Dermatol 2020; 47:1343-1373. [DOI: 10.1111/1346-8138.15618] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 01/19/2023]
Affiliation(s)
| | - Ryoji Tsuboi
- Department of Dermatology Tokyo Medical University TokyoJapan
| | - Ken Iozumi
- Department of Dermatology Tokyo Metropolitan Police Hospital TokyoJapan
| | - Sumiko Ishizaki
- Department of Dermatology Tokyo Women’s Medical University Medical Center East TokyoJapan
| | | | - Yumi Ogawa
- Department of Dermatology Juntendo University TokyoJapan
| | - Takehiko Kaneko
- Graduate School of Human Ecology Wayo Women’s University IchikawaJapan
| | - Masaaki Kawai
- Department of Dermatology Juntendo University Koshigaya Hospital KoshigayaJapan
| | - Yuki Kitami
- Department of Dermatology Showa University TokyoJapan
| | | | - Takeshi Kono
- Department of Dermatology Nippon Medical School Chibahokusoh Hospital InzaiJapan
| | | | - Tomotaka Sato
- Department of Dermatology Teikyo University Medical Center IchiharaJapan
| | - Harunari Shimoyama
- Department of Dermatology Teikyo University Mizonokuchi Hospital KawasakiJapan
| | - Motoi Takenaka
- Department of Dermatology Nagasaki University NagasakiJapan
| | | | - Gaku Tsuji
- Department of Dermatology Kyushu UniversityGraduate School of Medical Sciences FukuokaJapan
| | - Yuichiro Tsunemi
- Department of Dermatology Saitama Medical University MoroyamaJapan
| | - Yasuki Hata
- Kanagawa Hata Dermatology Clinic YokohamaJapan
| | | | - Tomoo Fukuda
- Department of Dermatology Saitama Medical Center KawagoeJapan
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Thamkhantho M, Chayachinda C. Vaginal tablets of dequalinium chloride 10 mg versus clotrimazole 100 mg for vaginal candidiasis: a double-blind, randomized study. Arch Gynecol Obstet 2020; 303:151-160. [PMID: 32940765 DOI: 10.1007/s00404-020-05784-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the clinical response, microscopic examination and fungal culture between dequalinium chloride (DQC) and clotrimazole (CT) for treating vaginal candidiasis (VC). METHODS The double-blind, randomized study was conducted from September 2014 to September 2016 at Siriraj Hospital, Thailand. Eligible participants were Thai women diagnosed with VC by microscopic examination. The exclusion criteria included immunocompromised conditions, consumption of antifungal drugs, and having recurrent VC. Each participant was randomized with a 1:1 allocation to receive six vaginal tablets of 100 mg CT or 10 mg DQC. Two visits included 10 ± 2 days (C1) and 38 ± 4 days (C2). Outcome measures were improvement of VC symptoms, microscopic examination, culture, satisfaction and tolerability. RESULTS Of 155 eligible participants, 150 were randomized and allocated into CT (N = 76) and DQC (N = 74). The average age was 31.1 ± 7.2 years. Comparable improvement of clinical response was demonstrated (OR at C1 0.79, 95% CI 0.56-1.10, p = 0.197; and OR at C2 0.99, 95% CI 0.69-1.43, p = 0.985). Of CT and DQC groups, the microscopic examination was positive at 11/75 (14.9%) vs 18/72 (25.3%) at C1 and 18/74 (24.3%) vs 28/66 (42.4%) at C2. And the culture was positive at 25/75 (33.8%) vs 46/72 (65.7%) at C1 and at 26/74 (36.6%) vs 46/66 (69.7%) at C2. Most participants had high satisfaction and tolerability and none reported any side effects. CONCLUSION DQC and CT show comparable clinical response but CT results in greater improvement of microscopic examination and fungal culture. CLINICAL TRIAL REGISTRATION The Clinical Trial Registry number was NCT02242695. (September 17, 2014).
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Affiliation(s)
- Manopchai Thamkhantho
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Chenchit Chayachinda
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
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Saxon Lead Author GDGC, Edwards A, Rautemaa-Richardson R, Owen C, Nathan B, Palmer B, Wood C, Ahmed H, Ahmad Patient Representatives S, FitzGerald Ceg Editor M. British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis (2019). Int J STD AIDS 2020; 31:1124-1144. [PMID: 32883171 DOI: 10.1177/0956462420943034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Guideline Development Group Cara Saxon Lead Author
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Anne Edwards
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Riina Rautemaa-Richardson
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Caroline Owen
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Bavithra Nathan
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Bret Palmer
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Clare Wood
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Humera Ahmed
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Sameena Ahmad Patient Representatives
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
| | - Mark FitzGerald Ceg Editor
- Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV (552485BASHH).,WRITING GROUP AFFILIATIONS.,Cara Saxon (Lead Author): Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Anne Edwards: Consultant Physician in Genitourinary Medicine, 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Riina Rautemaa-Richardson: Consultant in Medical Mycology, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Caroline Owen: Consultant Dermatologist, 8943East Lancashire Hospitals NHS Trust, Blackburn, UK.,Bavithra Nathan: Consultant Physician in Genitourinary Medicine, 4262Kingston Hospital NHS Foundation Trust, Kingston-upon-Thames, UK.,Bret Palmer: Specialty Trainee in Genitourinary Medicine, 14157Oxford Deanery, UK.,Clare Wood: Specialty Trainee in Genitourinary Medicine, 71404North Western Deanery, UK.,Humera Ahmed: Clinical Pharmacist, Manchester, UK.,Sameena Ahmad: Consultant Physician in Genitourinary Medicine, Withington Clinic, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Patient Representatives (see acknowledgments).,Mark FitzGerald: Clinical Effectiveness Group Editor.,MEMBERSHIP OF THE 552485BASHH CLINICAL EFFECTIVENESS GROUP.,Dr Keith Radcliffe (Chair), Dr Mark FitzGerald, Dr Deepa Grover, Dr Steve Higgins, Dr Margaret Kingston, Dr Michael Rayment, Dr Darren Cousins, Dr Ann Sullivan, Dr Helen Fifer, Dr Craig Tipple, Dr Sarah Flew, Dr Cara Saxon
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11
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Denison HJ, Worswick J, Bond CM, Grimshaw JM, Mayhew A, Gnani Ramadoss S, Robertson C, Schaafsma ME, Watson MC. Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush). Cochrane Database Syst Rev 2020; 8:CD002845. [PMID: 32845024 PMCID: PMC8095055 DOI: 10.1002/14651858.cd002845.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Anti-fungals are available for oral and intra-vaginal treatment of uncomplicated vulvovaginal candidiasis. OBJECTIVES The primary objective of this review is to assess the relative effectiveness (clinical cure) of oral versus intra-vaginal anti-fungals for the treatment of uncomplicated vulvovaginal candidiasis. Secondary objectives include the assessment of the relative effectiveness in terms of mycological cure, in addition to safety, side effects, treatment preference, time to first relief of symptoms, and costs. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and two trials registers on 29 August 2019 together with reference checking and citation searching. SELECTION CRITERIA We included randomised controlled trials published in any language comparing at least one oral anti-fungal with one intra-vaginal anti-fungal in women (aged 16 years or over) with a mycological diagnosis (positive culture, microscopy for yeast, or both) of uncomplicated vulvovaginal candidiasis. We excluded trials if they solely involved participants who were HIV positive, immunocompromised, pregnant, breast feeding or diabetic. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as recommended by Cochrane. MAIN RESULTS This review includes 26 trials (5007 participants). Eight anti-fungals are represented. All but three trials included participants with acute vulvovaginal candidiasis. Trials were conducted in Europe: UK (3), Croatia (2). Finland (2), the Netherlands (2), Germany (1), Italy (1), Sweden (1) and one trial across multiple European countries, USA (7) Thailand (2), Iran (2), Japan (1) and Africa (Nigeria) (1). The duration of follow-up varied between trials. The overall risk of bias of the included trials was high. There was probably little or no difference shown between oral and intra-vaginal anti-fungal treatment for clinical cure at short-term follow-up (OR 1.14, 95% CI 0.91 to 1.43; 13 trials; 1859 participants; moderate-certainty evidence) and long-term follow-up (OR 1.07, 95% CI 0.77 to 1.50; 9 trials; 1042 participants; moderate-certainty evidence). The evidence suggests that if the rate of clinical cure at short-term follow-up with intra-vaginal treatment is 77%, the rate with oral treatment would be between 75% and 83%; if the rate of clinical cure at long term follow-up with intra-vaginal treatment is 84%, the rate with oral treatment would be between 80% and 89%. Oral treatment probably improves mycological cure over intra-vaginal treatment at short term (OR 1.24, 95% CI 1.03 to 1.50: 19 trials; 3057 participants; moderate-certainty evidence) and long-term follow-up (OR 1.29, 95% CI 1.05 to 1.60; 13 trials; 1661 participants; moderate-certainty evidence). The evidence suggests that if the rate of mycological cure at short-term follow-up with intra-vaginal treatment is 80%, the rate with oral treatment would be between 80% and 85%; if the rate of mycological cure at long-term follow-up with intra-vaginal treatment is 66%, the rate with oral treatment would be between 67% and 76%. In terms of patient safety, there is a low risk of participants withdrawing from the studies due to adverse drug effects for either treatment (23 trials; 4637 participants; high-certainty evidence). Due to the low certainty of evidence, it is undetermined whether oral treatments reduced the number of side effects compared with intra-vaginal treatments (OR 1.04, 95% CI 0.84 to 1.29; 16 trials; 3155 participants; low-certainty evidence). The evidence suggests that if the rate of side effects with intra-vaginal treatment is 12%, the rate with oral treatment would be between 10% and 15%. We noted that the type of side effects differed, with intra-vaginal treatments being more often associated with local reactions, and oral treatments being more often associated with systemic effects including gastro-intestinal symptoms and headaches. Oral treatment appeared to be the favoured treatment preference over intra-vaginal treatment or no preference (12 trials; 2206 participants), however the data were poorly reported and the certainty of the evidence was low. There was little or no difference in time to first relief of symptoms between oral and intra-vaginal treatments: four trials favoured the oral treatment, four favoured intra-vaginal, one study reported no difference and one was unclear. The measurements varied between the 10 trials (1910 participants) and the certainty of the evidence was low. Costs were not reported in any of the trials. AUTHORS' CONCLUSIONS Oral anti-fungal treatment probably improves short- and long-term mycological cure over intra-vaginal treatment for uncomplicated vaginal candidiasis. Oral treatment was the favoured treatment preference by participants, though the certainty of this evidence is low. The decision to prescribe or recommend an anti-fungal for oral or intra-vaginal administration should take into consideration safety in terms of withdrawals and side effects, as well as cost and treatment preference. Unless there is a previous history of adverse reaction to one route of administration or contraindications, women who are purchasing their own treatment should be given full information about the characteristics and costs of treatment to make their own decision. If health services are paying the treatment cost, decision-makers should consider whether the higher cost of some oral anti-fungals is worth the gain in convenience, if this is the patient's preference.
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Affiliation(s)
- Hayley J Denison
- Centre for Public Health Research, Massey University - Wellington Campus, Wellington, New Zealand
| | - Julia Worswick
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
| | - Christine M Bond
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Margaret C Watson
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
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12
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Abstract
Vaginitis is defined as inflammation or infection of the vagina and is associated with a spectrum of symptoms, including vulvovaginal itching, burning, irritation, dyspareunia, "fishy" vaginal odor, and abnormal vaginal discharge. Vaginal symptoms are some of the most frequent reasons for patient visits to obstetrician-gynecologists () and may have important consequences in terms of discomfort and pain, days lost from school or work, sexual functioning, and self-image (). Distinguishing vaginal from vulvar symptoms is important to direct evaluation and treatment. The purpose of this document is to provide updated evidence-based guidance for the diagnosis and treatment of the common causes of vaginitis in nonpregnant patients. Information on the treatment of vaginitis in patients with human immunodeficiency virus (HIV) is covered elsewhere (). Guidelines are subject to change. For the most up-to-date information on vaginitis diagnosis and treatment, see the Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases webpage, which is available at https://www.cdc.gov/std/.
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13
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Lanis A, Talib HJ, Dodson N. Prepubertal and Adolescent Vulvovaginitis: What to Do When a Girl Reports Vaginal Discharge. Pediatr Ann 2020; 49:e170-e175. [PMID: 32275761 DOI: 10.3928/19382359-20200317-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Vaginitis presents with vaginal discharge, odor, pruritis, and/or discomfort and affects up to 75% of girls and women over the course of their lifetimes, with most women experiencing their first episode during adolescence. Given the prevalence of this disorder, this article aims to provide an overview of vaginitis for the general pediatrician. We start with prepubertal etiologies of vaginitis, then discuss pubertal and normal physiologic discharge, and then focus on the most common etiologies of adolescent vulvovaginitis. The three most common microbial etiologies of vaginitis (bacterial vaginosis, vulvovaginal candidiasis, and trichomonas) are addressed, as well as their diagnosis and treatment in adolescents. [Pediatr Ann. 2020;49(4):e170-e175.].
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14
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CD101 Topical Compared With Oral Fluconazole for Acute Vulvovaginal Candidiasis: A Randomized Controlled Trial. J Low Genit Tract Dis 2019; 23:226-229. [PMID: 30893271 DOI: 10.1097/lgt.0000000000000473] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Vulvovaginal candidiasis (VVC) is an infection of the vagina's mucous membranes, caused by Candida albicans in more than 90% of acute VVC. Several topical and oral azole agents are available in a variety of formulations, and all seem to have similar effectiveness. Azoles are fungistatic, meaning that the fungi are inhibited from growth or replication but are not eradicated. Recurrent infection and developing azole resistance demonstrate a significant need for alternative treatments. MATERIALS AND METHODS One hundred twenty-six women were randomized to 1 of the following 3 treatment cohorts: CD101 3% gel (n = 50) applied intravaginally on days 1 and 2, CD101 6% ointment (n = 50) applied intravaginally on day 1, or oral fluconazole 150 mg (n = 26) on day 1. Primary outcomes of clinical and mycological cure, as demonstrated by changes in the vaginal scores and mycological culture, were assessed on day 7 (±2 days), day 14 (±2 days), and day 28 (±7 days). Safety assessments included treatment-emergent adverse events. RESULTS Ninety-nine women with positive Candida culture remained in the modified intent-to-treat population with 40 in each CD101 arm and 19 in the fluconazole arm. In the CD101 gel, CD101 ointment, and oral fluconazole groups, 35%, 30%, and 52.6% demonstrated clinical cure and 45%, 40%, and 57.9% had mycological cure at day 28, respectively. CONCLUSIONS CD101 3% gel and CD101 6% ointment were well tolerated and produced similar rates of clinical and mycological cure in patients with an acute, moderate-to-severe episode of VVC. However, cure rates for these 2 formulations and regimens of CD101 were lower than those in patients treated with fluconazole.
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15
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Lírio J, Giraldo PC, Amaral RL, Sarmento ACA, Costa APF, Gonçalves AK. Antifungal (oral and vaginal) therapy for recurrent vulvovaginal candidiasis: a systematic review protocol. BMJ Open 2019; 9:e027489. [PMID: 31122991 PMCID: PMC6537984 DOI: 10.1136/bmjopen-2018-027489] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/11/2019] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Vulvovaginal candidiasis (VVC) is frequent in women worldwide and usually responds rapidly to topical or oral antifungal therapy. However, some women develop recurrent vulvovaginal candidiasis (RVVC), which is arbitrarily defined as four or more episodes every year. RVVC is a debilitating, long-term condition that can severely affect the quality of life of women. Most VVC is diagnosed and treated empirically and women frequently self-treat with over-the-counter medications that could contribute to an increase in the antifungal resistance. The effective treatment of RVVC has been a challenge in daily clinical practice. This review aims to assess the efficacy of antifungal agents administered orally or intravaginally for the treatment of RVVC, in order to define clinical practices that will impact on the reduction of the morbidity and antifungal resistance. METHODS AND ANALYSIS A comprehensive search of the following databases will be carried out: PubMed, Embase, Scopus, Web of Science, Scientific Electronic Library Online (SciELO), the Cochrane Central Register of Controlled Trials (CENTRAL), Biblioteca Virtual em Saúde (Virtual Health Library)/Biblioteca Regional de Medicina (Regional Library of Medicine) (BVS/BIREME), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and in the clinical trials databases (www.trialscentral.org; www.controlled-trials.com; www.clinicaltrials.gov). The risk of bias will be assessed according to the Cochrane Risk of Bias tool. We will perform data synthesis using the Review Manager (RevMan) software V.5.2.3. To assess heterogeneity, we will compute the I2 statistic. ETHICS AND DISSEMINATION This study will be a review of published data and it is not necessary to obtain ethical approval. Findings of this systematic review will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER CRD42018093817.
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Affiliation(s)
- Juliana Lírio
- Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Paulo Cesar Giraldo
- Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, Brazil
| | - Rose Luce Amaral
- Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, Brazil
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16
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Qin F, Wang Q, Zhang C, Fang C, Zhang L, Chen H, Zhang M, Cheng F. Efficacy of antifungal drugs in the treatment of vulvovaginal candidiasis: a Bayesian network meta-analysis. Infect Drug Resist 2018; 11:1893-1901. [PMID: 30425538 PMCID: PMC6203166 DOI: 10.2147/idr.s175588] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Antifungal drugs are used frequently in the treatment of vulvovaginal candidiasis (VVC), but have shown controversial results. In this study, we aimed to evaluate the effectiveness of different antifungal drugs in the treatment of VVC and to provide an evidence-based reference for clinical use. METHODS The published studies on the effectiveness of antifungal drugs in the treatment of VVC (up to April 2018) were retrieved from PubMed, Embase, the Cochrane Library, and Clini-calTrials.gov. We sifted through the literature according to Patients, Interventions, Comparisons and Outcomes principle, extracted data on the basic characteristics of the study, and evaluated the quality of included studies. We used R software for statistical analysis. RESULTS In total, 41 randomized controlled trials were included in this meta-analysis. The relative risk of VVC associated with ten drugs, including placebo, fluconazole, clotrimazole, miconazole, itraconazole, ketoconazole, econazole, butoconazole, terbinafine, and terconazole, was analyzed. The following drugs appeared to show more efficacy than placebo in the treated patients: fluconazole (OR =6.45, 95% CrI 4.42-9.41), clotrimazole (OR =2.99, 95% CrI 1.61-5.55), miconazole (OR =5.96, 95% CrI 3.17-11.2), itraconazole (OR =2.29, 95% CrI 1.21-4.33), ketoconazole (OR =2.40, 95% CrI 1.55-3.71), butoconazole (OR =1.18, 95% CrI 1.06-1.31), and terconazole (OR =5.60, 95% CrI 2.78-11.3). The value of surface under the cumulative ranking curve of each drug was as follows: placebo (0.5%), fluconazole (91.5%), clotrimazole (61.8%), miconazole (33.8%), itraconazole (50.5%), ketoconazole (42.8%), econazole (46.8%), butoconazole (82.2%), terbinafine (20.9%), and terconazole (65.0%). CONCLUSION Antifungal drugs are effective in the treatment of VVC. Fluconazole appeared to be the best drug for the treatment of VVC according to our analysis.
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Affiliation(s)
- Fen Qin
- Department of Obstetrics and Gynecology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Quan Wang
- Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Chunlian Zhang
- Department of Obstetrics and Gynecology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Caiyun Fang
- Department of Obstetrics and Gynecology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Liping Zhang
- Department of Obstetrics and Gynecology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Hailin Chen
- Department of Obstetrics and Gynecology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Mi Zhang
- Department of Cardiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China,
| | - Fei Cheng
- Department of Cardiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China,
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Abstract
Vaginal complaints are one of the most common reasons women seek the advice of a health care provider. Uncomplicated infections such as vulvovaginal candidiasis, bacterial vaginosis, or trichomoniasis are easy to diagnose and treat. However, about 8% of patients will have a more complicated course with failure to respond to treatment or rapid recurrence of symptoms. Understanding the need for a methodical, diagnostic approach to help these women with recurrent or refractory cases of vaginal symptoms will aid the clinician achieve successful patient outcomes.
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Affiliation(s)
- Benjie Brown Mills
- Department of Obstetrics & Gynecology, Greenville Health System, University of South Carolina School of Medicine-Greenville, 890 West Faris Road, Suite 470, Greenville, SC 29605, USA.
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18
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Recent advances in delivery of antifungal agents for therapeutic management of candidiasis. Biomed Pharmacother 2017; 96:1478-1490. [PMID: 29223551 DOI: 10.1016/j.biopha.2017.11.127] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/17/2017] [Accepted: 11/27/2017] [Indexed: 01/08/2023] Open
Abstract
Candidiasis is a fungal infection caused by yeasts that belong to the genus Candida. There are over twenty species of Candida yeasts that can cause infection in humans, the most common of which is Candida albicans. Candida yeasts normally reside in the intestinal tract and can be found on mucous membranes and skin without causing infection; however, overgrowth of these organisms can cause symptoms to develop. Presence of other diseases that compromises the patient's immunity makes it more difficult to treat. Candidiasis is majorly divided into superficial infections (oral or vaginal) and systemic infections, also known as invasive candidiasis. The conventional therapeutic modalities used to treat candidiasis are associated with several side effects that limits the dose and dosing frequency. Development of novel drug delivery systems for reduction in dose and alleviation of side effects is an important strategy to improve the clinical efficacy and patient acceptability. This review gives a bird's eye view of the classification and current therapeutic regime of candidiasis. It presents the varied types of drug delivery systems that have been exploited for delivery of antifungal agents with measurable benefits. It also touches upon echinocandins a relatively new class of drugs that are amenable for translation into novel dosage forms with application against biofilm producing and fluconazole resistant strains contributing to a better therapeutic management of candidiasis.
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Akudo Nwagbara B, Effa EE, Abubakar D, Osagie OE. Interventions to improve vaginal health for reducing the risk of HIV acquisition. Hippokratia 2017. [DOI: 10.1002/14651858.cd009869.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Emmanuel E Effa
- College of Medical Sciences, University of Calabar; Internal Medicine; PMB 1115 Calabar Cross River State Nigeria 540001
| | - Danladi Abubakar
- Federal Medical Center; Obstetrics and Gynaecology; Gusau Zamfara State Nigeria
| | - Osayande E Osagie
- University of Melbourne; School of Public Health; Melbourne Victoria Australia
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21
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Rhew ZI, Han Y. Synergic effect of combination of glycyrol and fluconazole against experimental cutaneous candidiasis due to Candida albicans. Arch Pharm Res 2016; 39:1482-1489. [PMID: 27572154 DOI: 10.1007/s12272-016-0824-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
Abstract
In this study, we investigated the anti-fungal activity of glycyrol, a coumarine isolated from licorice (Glycyrrhizae Radix), in a murine model of cutaneous candidiasis caused by Candida albicans. Compared to the infected sites, located on the mice's back, of the untreated control mice, the infected sites treated with glycyrol had reduced CFU (colony forming unit) values up to 60 and 85.5 % at 20 and 40 μg/mouse of glycyrol, respectively (P < 0.01). The antifungal activity of glycyrol was synergistically increased when glycyrol (10 μg/mouse) was combined with fluconazole (10 μg/mouse), demonstrating that the combination therapy is approximately 4 times more effective than fluconazole alone at 20 μg/mouse (P < 0.01). Additionally, the combination activity was 1.65 times greater than the antifungal activity of fluconazole alone at 40 μg/mouse (P < 0.05). In seeking glycyrol's antifungal mechanism, we determined that glycyrol inhibited hyphal induction and cell wall adherence of C. albicans. Thus, it is very likely that, by damaging the cell wall, glycyrol helps fluconazole invade C. albicans more readily and attack fluconazole's target in the fungus membrane. In summary, our data indicate that glycyrol may contribute to the development of a novel agent that possesses antifungal activity against cutaneous candidiasis.
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Affiliation(s)
- Zheong-Imm Rhew
- Department of ImmunoMicrobiology, College of Pharmacy, Dongduk Women's University, 23-1 Wolgok-Dong, Sungbuk-Gu, Seoul, 136-714, Korea
| | - Yongmoon Han
- Department of ImmunoMicrobiology, College of Pharmacy, Dongduk Women's University, 23-1 Wolgok-Dong, Sungbuk-Gu, Seoul, 136-714, Korea.
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22
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Abstract
Fungal pathogens can lead to many of the complications seen in advanced HIV disease and are commonly identified in HIV-infected populations with decreased immune function. Common fungal organisms affecting individuals with AIDS include Cryptococcus neoformans, various Candida species, and Histoplasma capsulatum. While infection with these organisms can be fatal, appropriate identification and management of the condition can result in reduced mortality and the opportunity for effectivemanagement of HIV disease with highly active antiretroviral therapy. This article describes the clinical presentation and treatment of 3 fungal infections common in the immunocompromised individual with AIDS. Current antifungal therapy for themanagement of these infections is discussed. In addition, the role of newer antifungal agents in the setting of these conditions is reviewed.
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Affiliation(s)
- Melody L. Duffalo
- Penn Community Infectious Diseases, Penn Presbyterian Medical Center, 51 North 39th Street, Suite W241, Philadelphia, PA 19104
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Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1-50. [PMID: 26679628 PMCID: PMC4725385 DOI: 10.1093/cid/civ933] [Citation(s) in RCA: 1812] [Impact Index Per Article: 226.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 02/06/2023] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
| | - Carol A Kauffman
- Veterans Affairs Ann Arbor Healthcare System and University of Michigan Medical School, Ann Arbor
| | | | | | - Kieren A Marr
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Thomas J Walsh
- Weill Cornell Medical Center and Cornell University, New York, New York
| | | | - Jack D Sobel
- Harper University Hospital and Wayne State University, Detroit, Michigan
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Chew SY, Than LTL. Vulvovaginal candidosis: contemporary challenges and the future of prophylactic and therapeutic approaches. Mycoses 2016; 59:262-73. [PMID: 26765516 DOI: 10.1111/myc.12455] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/19/2015] [Accepted: 12/08/2015] [Indexed: 12/16/2022]
Abstract
Vulvovaginal candidosis (VVC) is a common gynaecological disorder that is delineated by the inflammation of vaginal wall and it is caused by the opportunistic fungal pathogen Candida species. In fact, three out of every four women will experience at least one occasion of VVC during some point in their lives. Although uncomplicated VVC is relatively harmless, the complicated VVC such as recurrent attack often creates restlessness and depression in the patients, thus greatly affects their quality of life. Managements of VVC are usually associated with the use of antimycotic suppositories, topical cream or oral agents. These antimycotic agents are either available over-the-counter or prescribed by the clinicians. In recent decades, the rise of clinical challenges such as the increased prevalence of resistant Candida strains, recurrent VVC infection and adverse effects of multidrug interactions have necessitated the development of novel therapeutic or prophylactic options to combat the complicated VVC in the future. In this review, we discuss the current antimycotic treatments available for Candida vaginitis and the problems that exist in these seemingly effective treatments. Besides, we attempt to contemplate some of the future and prospective strategies surrounding the development of alternative therapeutic and prophylactic options in treating and preventing complicated VVC respectively.
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Affiliation(s)
- Shu Yih Chew
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43300, Serdang, Selangor, Malaysia
| | - Leslie Thian Lung Than
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43300, Serdang, Selangor, Malaysia
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26
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Gonçalves B, Ferreira C, Alves CT, Henriques M, Azeredo J, Silva S. Vulvovaginal candidiasis: Epidemiology, microbiology and risk factors. Crit Rev Microbiol 2015; 42:905-27. [PMID: 26690853 DOI: 10.3109/1040841x.2015.1091805] [Citation(s) in RCA: 318] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Vulvovaginal candidiasis (VVC) is an infection caused by Candida species that affects millions of women every year. Although Candida albicans is the main cause of VVC, the identification of non-Candida albicans Candida (NCAC) species, especially Candida glabrata, as the cause of this infection, appears to be increasing. The development of VVC is usually attributed to the disturbance of the balance between Candida vaginal colonization and host environment by physiological or nonphysiological changes. Several host-related and behavioral risk factors have been proposed as predisposing factors for VVC. Host-related factors include pregnancy, hormone replacement, uncontrolled diabetes, immunosuppression, antibiotics, glucocorticoids use and genetic predispositions. Behavioral risk factors include use of oral contraceptives, intrauterine device, spermicides and condoms and some habits of hygiene, clothing and sexual practices. Despite a growing list of recognized risk factors, much remains to be elucidated as the role of host versus microorganisms, in inducing VVC and its recurrence. Thus, this review provides information about the current state of knowledge on the risk factors that predispose to VVC, also including a revision of the epidemiology and microbiology of VVC, as well as of Candida virulence factors associated with vaginal pathogenicity.
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Affiliation(s)
- Bruna Gonçalves
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Carina Ferreira
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Carlos Tiago Alves
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Mariana Henriques
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Joana Azeredo
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
| | - Sónia Silva
- a CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho , Braga , Portugal
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Malbakhova YET, Arzumanyan VG. Current concept of the diagnostics and treatment of vulvovaginal candidosis. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-2-111-115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
In spite of high prevalence of vulvovaginal candidosis (VVC), its diagnostics and treatment pose a serious problem. Factors such as accessibility of antimycotic drugs, their uncontrolled application by patients and absence of any appropriate laboratory diagnostics result in the growth of the incidence rate, in particular, of recurrent forms related to a steady growth in the number of fungi of clinical importance as well as strains resistant to antifungal drugs. Discussion and conclusion. Today the problem of the need to develop VVC prevention drugs is increasingly urgent because reduced immunity results in relapses of the disease. Clinical trials of drugs for immune system correction are ongoing, and some of them have reached Phase 2. Based on the present-day research data, it is possible to conclude that the key standards for VVC diagnostics and treatment are as follows: mandatory diagnostics with the use of microbiological tests to determine the sensitivity to antifungal medicines, in particular, in case of recurrent VVC, and collection of detailed medical history data and physical examination to determine the form and severity of the disease (acute, recurrent, complicated or uncomplicated) and treatment duration: 1-7 days for acute uncomplicated forms and 7-14 days for recurrent complicated forms. The specific drug and route of administration are to be selected based on the physician’s preferences, patient’s convenience and cost of the drug provided the drug sensitivity is determined by laboratory tests. The administration of probiotics for VVC prevention and treatment is disputable today.
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28
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Fan S, Liu X, Liang Y. Miconazole nitrate vaginal suppository 1,200 mg versus oral fluconazole 150 mg in treating severe vulvovaginal candidiasis. Gynecol Obstet Invest 2015; 80:113-8. [PMID: 25720546 DOI: 10.1159/000371759] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 12/26/2014] [Indexed: 11/19/2022]
Abstract
AIMS Miconazole is a synthetic imidazole antifungal that has a broad spectrum of activity against Candida albicans and non-albicans Candida species. The aim of this study was to evaluate the efficacy and safety of miconazole nitrate vaginal suppository and oral fluconazole in treating severe vulvovaginal candidiasis (SVVC). METHODS In this prospective, randomized case control study, 577 cases of consecutive patients with SVVC were studied at the Gynecological Clinic of Peking University Shenzhen Hospital from January 1, 2009 through December 31, 2010. Patients with SVVC were treated with two doses of miconazole nitrate vaginal suppository 1,200 mg or two doses of fluconazole 150 mg. The patients were followed up for 7-14 and 30-35 days following the second dose of therapy. RESULTS The mycological cure rates of the patients on days 7-14 of follow-up were 75.9% (220/290) and 84.0% (241/287) in the miconazole and fluconazole groups, respectively (p < 0.05). The mycological cure rates of the patients at the second follow-up were 64.8% (188/290) and 69.7% (200/287), respectively, in the two groups (p > 0.05). CONCLUSION The study demonstrated that two doses of miconazole nitrate vaginal suppository 1,200 mg were as effective as two doses of an oral fluconazole 150 mg regimen in the treatment of patients with SVVC.
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Affiliation(s)
- Shangrong Fan
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
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29
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Choukri F, Benderdouche M, Sednaoui P. In vitro susceptibility profile of 200 recent clinical isolates of Candida spp. to topical antifungal treatments of vulvovaginal candidiasis, the imidazoles and nystatin agents. J Mycol Med 2014; 24:303-7. [PMID: 25442913 DOI: 10.1016/j.mycmed.2014.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 04/27/2014] [Accepted: 05/12/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Topical antifungal treatment of vulvovaginal candidiasis is widely recommended. The most commonly recommended topical antifungals (the imidazoles clotrimazole, miconazole and econazole and the polyene nystatin) have been on the market for more than 30 years. There are only a few recent data available on the susceptibility of different Candida species to these antifungals, especially of non-albicans Candida species which appear to be less responsive to treatment with imidazoles. The study aimed to determine the in vitro susceptibility profile of a large number of recent clinical isolates of Candida spp. to the most commonly recommended topical antifungals. MATERIALS AND METHODS An antifungal susceptibility test was performed according to the CLSI M27-A3 broth microdilution method, and minimal inhibitory concentrations were determined for econazole, miconazole, clotrimazole and nystatin. RESULTS The clinical isolates comprised of: 113 Candida albicans, 54 Candida glabrata, 11 Candida krusei, 11 Candida tropicalis and 11 Candida parapsilosis. The three azoles agents exhibited MIC90 values of 0.06 mg/L against C. albicans isolates, while nystatin exhibited a MIC90 of 4 mg/L. For non-albicans Candida isolates, MIC90 values ranged from 0.5 to 8 mg/L, from 1 to 4 mg/L and from 0.12 to 4 mg/L, for econazole, miconazole, clotrimazole, respectively. Nystatin MIC90 remained at 4 mg/L for all non-albicans Candida species tested. CONCLUSION These results confirmed the susceptibility of C. albicans to the most frequently used topical agents and may support the use of alternative agents to imidazoles, such as nystatin, to treat vulvovaginal candidiasis caused by non-albicans Candida species.
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Affiliation(s)
- F Choukri
- Laboratoire de microbiologie, institut Alfred-Fournier, 25, boulevard Saint-Jacques, 75014 Paris, France.
| | - M Benderdouche
- Laboratoire de microbiologie, institut Alfred-Fournier, 25, boulevard Saint-Jacques, 75014 Paris, France
| | - P Sednaoui
- Laboratoire de microbiologie, institut Alfred-Fournier, 25, boulevard Saint-Jacques, 75014 Paris, France
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Johal HS, Garg T, Rath G, Goyal AK. Advanced topical drug delivery system for the management of vaginal candidiasis. Drug Deliv 2014; 23:550-63. [DOI: 10.3109/10717544.2014.928760] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Mendling W, Schlegelmilch R. Three-Day Combination Treatment for Vulvovaginal Candidosis with 200 mg Clotrimazol Vaginal Suppositories and Clotrimazol Cream for the Vulva is Significantly Better than Treatment with Vaginal Suppositories Alone - an Earlier, Multi-Centre, Placebo-Controlled Double Blind Study. Geburtshilfe Frauenheilkd 2014; 74:355-360. [PMID: 25076792 DOI: 10.1055/s-0034-1368243] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/17/2014] [Accepted: 02/23/2014] [Indexed: 10/25/2022] Open
Abstract
Problem: According to the guidelines, acute vulvovaginal candidosis (VVC) may be treated vaginally, through a combination of vaginal treatment and cream for the vulva or orally. However, there is a lack of investigations into whether combined treatment for the vagina and vulva achieves better results than vaginal treatment alone. Method: In 1999, 160 patients with vulvovaginal candidosis from ten German gynaecological practices were included in a study and treated on a randomised basis with three 200 mg clotrimazol vaginal suppositories = clotrimazol 2 % cream (verum n = 79) or + placebo (active-ingredient-free cream base n = 79). The examinations took place before treatment (T1), six to eight days following the end of treatment (T2) and approximately four weeks following the end of treatment (T3). In addition to demographic data, the clinical findings of each investigation were documented in a standardised way and a native preparation and a fungal culture were taken. The doctor and patient evaluated the healing process and tolerance. The main efficacy variables were the pre/post difference scores for extravaginal redness. Results: On T1, there was no difference between the two groups. By T2, there was a significant difference in the extent of extravaginal redness between the verum and the placebo groups (p = 0.0002), as well as in the subgroup of the per-protocol analysis (verum 64, placebo 70 patients, p = 0.0015). Genital itching or burning had entirely disappeared in 51 % and 56 % of patients respectively in the verum group and in only 30 % and 45 % of patients in the placebo group on T2 (p = 0.0181). There was no difference in intravaginal redness on T1 and T2 in either group. The overall assessment by the doctor went accordingly (p = 0.0004). On T1, the extravaginal fungal culture was positive in 75 women in the verum group and in 76 women in the placebo group. On T2, however, this was positive in 51.9 % (verum) and 73.1 % (placebo) of cases, and a positive culture was evinced in the vagina in 6 vs. 8 women (7.5 vs. 10.1 %, p = 0.3802). The local tolerance in both groups was 70 % very good, and 29 vs. 27 % good. After four weeks (T3), 16 out of 23 patients in the verum group and only 8 out of 21 in the placebo group had negative extravaginal fungal cultures. Discussion: There is a lack of studies into the issue of whether vaginal treatment or combined vulvovaginal treatment of acute VVC would be more advantageous. However, there are two studies that support the significant results of this paper that when it comes to acute VVC, the combination of three 200 mg clotrimazol vaginal suppositories with clotrimazol cream 2 % is better than with vaginal suppositories alone.
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Affiliation(s)
- W Mendling
- Deutsches Zentrum für Infektionen in Gynäkologie und Geburtshilfe, Wuppertal
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32
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Rathod SD, Buffler PA. Highly-cited estimates of the cumulative incidence and recurrence of vulvovaginal candidiasis are inadequately documented. BMC WOMENS HEALTH 2014; 14:43. [PMID: 24612727 PMCID: PMC3975582 DOI: 10.1186/1472-6874-14-43] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 03/05/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Available literature concerning the epidemiologic or clinical features of vulvovaginal candidiasis commonly reports that: 75% of women will experience an episode of vulvovaginal candidiasis in their lifetimes, 50% of whom will experience at least a second episode, and 5-10% of all women will experience recurrent vulvovaginal candidiasis (≥4 episodes/1 year). In this debate we traced the three commonly cited statistics to their presumed origins. DISCUSSION It is apparent that these figures were inadequately documented and lacked supporting epidemiologic evidence. Population-based studies are needed to make reliable estimates of the lifetime risk of vulvovaginal candidiasis and the proportion of women who experience recurrent candidiasis. SUMMARY The extent to which vulvovaginal candidiasis is a source of population-level morbidity remains uncertain.
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Affiliation(s)
- Sujit D Rathod
- Division of Epidemiology, University of California, Berkeley, USA.
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Sobel JD. Factors involved in patient choice of oral or vaginal treatment for vulvovaginal candidiasis. Patient Prefer Adherence 2013; 8:31-4. [PMID: 24368881 PMCID: PMC3869914 DOI: 10.2147/ppa.s38984] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Vulvovaginal candidiasis (VVC) is an extremely common cause of vaginal symptoms in women. Multiple antifungal products are available by either the oral or vaginal route, although no new drugs have become available for two decades. Given the therapeutic equivalence of the antimycotic agents and their routes of administration, the specific drug and formulation selected is entirely arbitrary in relation to final treatment outcome. Nevertheless, multiple factors affecting preference, both practitioner-dependent and patient-dependent, impact on selection of a specific drug and route of administration.
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Affiliation(s)
- Jack D Sobel
- Division of Infectious Diseases, Wayne, State University School of Medicine, Detroit, MI, USA
- Correspondence: Jack D Sobel, Division of Infectious Diseases, Harper University Hospital, 3990 John R, Detroit, MI 48201, USA, Tel +1 313 745 7105, Fax +1 313 993 0302, Email
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Abstract
For practitioners, selecting successful therapy for vulvovaginal candidiasis is anything but trivial. The dominant problem; however, lies not with selecting the correct antimycotic agent, but with making the correct diagnosis and not treating non-yeast infections and noninfections as yeast-induced. Moreover, not all cases of vulvovaginal candidiasis are equal and practitioners owe patients the obligation of selecting appropriate therapy based upon the specific type and severity of vulvovaginal candidiasis. Uncomplicated candidiasis is readily treated with short-term oral or topical therapy, whereas complicated candidiasis needs additional strategies using the plethora of therapies available. Problematic refractory cases still abound and the pipeline for new, more potent antifungal agents is largely empty. Management strategies for complicated Candida vaginitis are discussed.
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Affiliation(s)
- Jack Sobel
- Division of Infectious Diseases, Wayne State University School of Medicine, Harper Hospital, 3990 John R, 4 Brush Center, Detroit, MI, USA.
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Cooke G, Watson C, Smith J, Pirotta M, van Driel ML. Treatment for recurrent vulvovaginal candidiasis (thrush). Hippokratia 2011. [DOI: 10.1002/14651858.cd009151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Georga Cooke
- Bond University; Faculty of Health Sciences and Medicine; University Dr. Gold Coast Queensland Australia 4229
| | - Cathy Watson
- University of Melbourne; Department of General Practice; 200 Berkeley St. Carlton Victoria Australia 3053
| | - Jane Smith
- Bond University; Faculty of Health Sciences and Medicine; University Dr. Gold Coast Queensland Australia 4229
| | - Marie Pirotta
- University of Melbourne; General Practice; 200 Berkeley St. Carlton Victoria Australia 3053
| | - Mieke L van Driel
- Bond University; Faculty of Health Sciences and Medicine; University Dr. Gold Coast Queensland Australia 4229
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Del-Cura González I, García-de-Blas González F, Cuesta TS, Martín Fernández J, Del-Alamo Rodríguez JM, Escriva Ferrairo RA, Del Canto De-Hoyos Alonso M, Arenas LB, Barrientos RR, Wiesmann EC, De-Alba Romero C, Díaz YG, Rodríguez-Moñino AP, Teira BG, Del Pozo MSC, Horcajuelo JF, Rojas Giraldo MJ, González PC, Vello Cuadrado RA, Uriarte BL, Yepes JS, Sanz YH, Iglesias Piñeiro MJ, Hernández ST, Alonso FG, González González AI, Fernández AS, Carballo C, López AR, Morales F, Martínez López D. Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care. BMC Public Health 2011; 11:63. [PMID: 21281464 PMCID: PMC3048533 DOI: 10.1186/1471-2458-11-63] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 01/31/2011] [Indexed: 11/19/2022] Open
Abstract
Background Vaginitis is a common complaint in primary care. In uncomplicated candidal vaginitis, there are no differences in effectiveness between oral or vaginal treatment. Some studies describe that the preferred treatment is the oral one, but a Cochrane's review points out inconsistencies associated with the report of the preferred way that limit the use of such data. Risk factors associated with recurrent vulvovaginal candidiasis still remain controversial. Methods/Design This work describes a protocol of a multicentric prospective observational study with one year follow up, to describe the women's reasons and preferences to choose the way of administration (oral vs topical) in the treatment of not complicated candidal vaginitis. The number of women required is 765, they are chosen by consecutive sampling. All of whom are aged 16 and over with vaginal discharge and/or vaginal pruritus, diagnosed with not complicated vulvovaginitis in Primary Care in Madrid. The main outcome variable is the preferences of the patients in treatment choice; secondary outcome variables are time to symptoms relief and adverse reactions and the frequency of recurrent vulvovaginitis and the risk factors. In the statistical analysis, for the main objective will be descriptive for each of the variables, bivariant analysis and multivariate analysis (logistic regression).. The dependent variable being the type of treatment chosen (oral or topical) and the independent, the variables that after bivariant analysis, have been associated to the treatment preference. Discussion Clinical decisions, recommendations, and practice guidelines must not only attend to the best available evidence, but also to the values and preferences of the informed patient.
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Affiliation(s)
- Isabel Del-Cura González
- Unidad de Investigación, Atención Primaria Area 9, Servicio Madrileño de Salud, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain.
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Isolation and genotyping of vaginal non-albicans Candidaspp. in women from two different ethnic groups in Lanzhou, China. Int J Gynaecol Obstet 2010; 110:227-30. [DOI: 10.1016/j.ijgo.2010.04.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Revised: 04/02/2010] [Accepted: 05/12/2010] [Indexed: 11/24/2022]
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Sobel JD. Vaginitis, vulvitis, cervicitis and cutaneous vulval lesions. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00049-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Witt A, Kaufmann U, Bitschnau M, Tempfer C, Ozbal A, Haytouglu E, Gregor H, Kiss H. Monthly itraconazole versus classic homeopathy for the treatment of recurrent vulvovaginal candidiasis: a randomised trial. BJOG 2009; 116:1499-505. [PMID: 19583713 DOI: 10.1111/j.1471-0528.2009.02262.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Antimycotics effectively treat sporadic and recurrent vulvovaginal candidiasis (RVVC). Classic homeopathy (CH) is also used to treat this condition. We compared the efficacy of CH and itraconazole in reducing the frequency of RVVC episodes. DESIGN Single-centre, prospective, randomised trial. SAMPLE One hundred-and-fifty patients with a history of RVVC and an acute episode of VVC. METHODS Women were randomised into 3 groups: itraconazole with lactobacilli (group 1), itraconazole without lactobacilli (group 2) and CH (group 3). Itraconazole treatment of acute infection was followed by a 6-month maintenance regimen with monthly single-day itraconazole (200 mg bid). Women in group 1 were given additional vaginal lactobacilli for 6 days per month throughout the maintenance regimen Thereafter, patients were followed without treatment for 6 months. CH treatment was performed for 12 months. RESULTS Women in groups 1 and 2 reached a culture-free status significantly earlier than women in group 3 (log-rank test; P < 0.0001). Specifically, before the start of the maintenance regimen, 44 of 49 women (89.8%) in group 1 and 40 of 47 women (85%) in group 2 were free of Candida detectable by culture, 22 of 46 (47%) women in group 3 reached a culture-free status after the first visit, but had a recurrence significantly earlier compared with women in groups 1 and 2 (log-rank test; P = 0.002). After 12 months, 19 of 25 (76%) women in group 1, 18 of 23 (78%) women in group 2 and 9 of 23 (39%) women in group 3 were free of culture-detectable Candida. Assessment of RVVC-associated complaints by VAS score showed that women in group 3 had a significantly higher level of discomfort (36.8, 25.1 and 27.7 respectively; P < 0.001) and were significantly less satisfied (59.2, 68.2 and 71.7 respectively; P < 0.001) than patients in groups 1 and 2. CONCLUSIONS Monthly cycle-dependent itraconazole is more effective than CH in the treatment of RVVC. Lactobacilli do not confer an added benefit.
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Affiliation(s)
- A Witt
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.
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Gómez-López A, Zaragoza O, Rodríguez-Tudela JL, Cuenca-Estrella M. Pharmacotherapy of yeast infections. Expert Opin Pharmacother 2009; 9:2801-16. [PMID: 18937613 DOI: 10.1517/14656566.9.16.2801] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The rise of immunocompromised individuals in our society has provoked a significant emergence in the number of patients affected by opportunistic pathogenic yeast. The microorganisms with a major clinical incidence are species from the genera Candida (especially Candida albicans) and Cryptococcus (particularly Cryptococcus neoformans), although there has been a significant increase in other pathogenic yeasts, such as Trichosporon spp. and Rhodotorula spp. In addition, there are an increasing number of patients infected by yeasts that were not previously considered as pathogenic, such as Saccharomyces cerevisiae. The management of these infections is complicated and is highly dependent on the susceptibility profile not only of the species but also of the strain. The available antifungal compounds belong mainly to the polyene, azole and candin families, which show a distinct spectrum of activity. This review summarizes the current knowledge about the use of the main antifungals for treating infections caused by the yeast species with the most significant clinical relevance, including the susceptibility profiles exhibited by these species in vitro.
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Affiliation(s)
- Alicia Gómez-López
- Instituto de Salud Carlos III, Servicio de Micología, Centro Nacional de Microbiología, Carretera Majadahonda-Pozuelo, Km2, Majadahonda 28220, Madrid, Spain
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McClelland RS, Richardson BA, Hassan WM, Chohan V, Lavreys L, Mandaliya K, Kiarie J, Jaoko W, Ndinya-Achola JO, Baeten JM, Kurth AE, Holmes KK. Improvement of vaginal health for Kenyan women at risk for acquisition of human immunodeficiency virus type 1: results of a randomized trial. J Infect Dis 2008; 197:1361-8. [PMID: 18444793 PMCID: PMC4122228 DOI: 10.1086/587490] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Vaginal infections are common and have been associated with increased risk for acquisition of human immunodeficiency virus type 1 (HIV-1). METHODS We conducted a randomized trial of directly observed oral treatment administered monthly to reduce vaginal infections among Kenyan women at risk for HIV-1 acquisition. A trial intervention of 2 g of metronidazole plus 150 mg of fluconazole was compared with metronidazole placebo plus fluconazole placebo. The primary end points were bacterial vaginosis (BV), vaginal candidiasis, trichomoniasis vaginalis (hereafter, "trichomoniasis"), and colonization with Lactobacillus organisms. RESULTS Of 310 HIV-1-seronegative female sex workers enrolled (155 per arm), 303 were included in the primary end points analysis. A median of 12 follow-up visits per subject were recorded in both study arms (P = .8). Compared with control subjects, women receiving the intervention had fewer episodes of BV (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.49-0.63) and more frequent vaginal colonization with any Lactobacillus species (HR, 1.47; 95% CI, 1.19-1.80) and H(2)O(2)-producing Lactobacillus species (HR, 1.63; 95% CI, 1.16-2.27). The incidences of vaginal candidiasis (HR, 0.84; 95% CI, 0.67-1.04) and trichomoniasis (HR, 0.55; 95% CI, 0.27-1.12) among treated women were less than those among control subjects, but the differences were not statistically significant. CONCLUSIONS Periodic presumptive treatment reduced the incidence of BV and promoted colonization with normal vaginal flora. Vaginal health interventions have the potential to provide simple, female-controlled approaches for reducing the risk of HIV-1 acquisition.
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Patel Y, Gopalan S, Bagga R, Sharma M, Chopra S, Sethi S. A randomized trial comparing a polyherbal pessary (a complementary and alternative medicine) with Ginlac-V pessary (containing clotrimazole, tinidazole and lactobacilli) for treatment of women with symptomatic vaginal discharge. Arch Gynecol Obstet 2008; 278:341-7. [PMID: 18236058 DOI: 10.1007/s00404-008-0568-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2007] [Accepted: 01/08/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Most women with abnormal vaginal discharge have infection due to candida species, bacterial vaginosis or trichomoniasis and often seek treatment without laboratory confirmation. In this context, a single agent effective against these infections would be useful. AIM To compare the efficacy of two such agents: Praneem polyherbal pessary; a complementary and alternative medicine (CAM) with Ginlac-V pessary (containing clotrimazole, tinidazole and lactobacilli) for treatment of abnormal vaginal discharge. SETTINGS AND DESIGN A randomized study in a tertiary care hospital in North India. METHODS One hundred women were randomized for treatment with either of the two pessaries. Clinical examination and laboratory evaluation was done before and after treatment. STATISTICAL ANALYSIS Mc-Nemar test and Chi-square test. RESULTS Overall, 82% (82/100) reported symptomatic relief; 78% (39/50) with Praneem and 86% (43/50) with Ginlac-V. Only 36% (18/50 in each group) had laboratory-confirmed infection; 18% (18/100) candidosis, 17% (17/100) bacterial vaginosis, 1% (1/100) both; none had trichomoniasis. Among these, symptomatic improvement was seen in 72% (13/18) and laboratory cure in 78% (14/18) with Praneem; symptomatic improvement in 78% (14/18) and laboratory cure in 78% (14/18) with Ginlac-V. Clinical or laboratory criteria could assess treatment efficacy equally. Neither drug was efficacious in candidosis. Ginlac-V was efficacious in bacterial vaginosis (100%) and though Praneem showed a similar trend, it was not statistically significant. Vaginal irritation was more frequent with Praneem (16% vs 4% with Ginlac-V). CONCLUSION Both Praneem and Ginlac-V provided symptomatic relief in most of the women. Either clinical or laboratory criteria could assess treatment efficacy of both drugs. Ginlac-V was efficacious for treating bacterial vaginosis.
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Affiliation(s)
- Yamal Patel
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
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Nurbhai M, Grimshaw J, Watson M, Bond C, Mollison J, Ludbrook A. Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush). Cochrane Database Syst Rev 2007:CD002845. [PMID: 17943774 DOI: 10.1002/14651858.cd002845.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Anti-fungals are available for oral and intra-vaginal treatment of uncomplicated vulvovaginal candidiasis (thrush). OBJECTIVES The primary objective of this review was to assess the relative effectiveness of oral versus intra-vaginal anti-fungals for the treatment of uncomplicated vulvovaginal candidiasis. The secondary objectives of the review were to assess the cost-effectiveness, safety and patient preference of oral versus intra-vaginal anti-fungals. SEARCH STRATEGY The following sources were searched for the original review: The Cochrane Library (Issue 4, 1999), MEDLINE (January 1985 to May 2000), EMBASE (January 1980 to January 2000) and the Cochrane Sexually Transmitted Disease (STD) Group Specialised Register of Controlled Trials. The manufacturers of anti-fungals available in the UK were contacted. For the update, CENTRAL (January 2000 to August 2006), PUBMED (January 2000 to August 2006), EMBASE (January 2000 to August 2006) and the Cochrane STD Group Specialised Register were searched in August 2006. The reference lists of retrieved articles were reviewed manually. SELECTION CRITERIA Randomised controlled trials published in any language. Trials had to compare at least one oral anti-fungal with one intra-vaginal anti-fungal. Women (aged 16 years or over) with uncomplicated vulvovaginal candidiasis. The diagnosis of vulvovaginal candidiasis to be made mycologically (i.e. a positive culture and / or microscopy for yeast). Trials were excluded if they solely involved subjects who were HIV positive, immunocompromised, pregnant, breast feeding or diabetic. The primary outcome measure was clinical cure. DATA COLLECTION AND ANALYSIS Two reviewers screened titles and abstracts of the electronic search results and full text of potentially relevant papers. Independent duplicate abstraction was performed by two reviewers. Disagreements regarding trial inclusion or data abstraction were resolved by discussion between the reviewers. Odds ratios were pooled using the fixed effects models (except for two analyses when random effects models were used because of potentially important heterogeneity). MAIN RESULTS Two new trials reporting three comparisons were found in the update. Nineteen trials are included in the review, reporting 22 oral versus intra-vaginal anti-fungal comparisons. No statistically significant differences were shown between oral and intra-vaginal anti-fungal treatment for clinical cure at short term (OR 0.94, 95% CI, 0.75 to 1.17) and long term (OR 1.07, 95% CI, 0.82 to 1.41) follow-up. No statistically significant differences for mycological cure were observed between oral and intra-vaginal treatment at short term (OR 1.15, 95% CI, 0.94 to 1.42). There was a statistically significant difference for long term follow-up (OR 1.29, 95% CI, 1.05 to 1.60) in favour of oral treatment, however the clinical significance of this result is uncertain. Two trials each reported one withdrawal from treatment due to an adverse reaction. Treatment preference data were poorly reported. AUTHORS' CONCLUSIONS No statistically significant differences were observed in clinical cure rates of anti-fungals administered by the oral and intra-vaginal routes for the treatment of uncomplicated vaginal candidiasis. No definitive conclusion can be made regarding the relative safety of oral and intra-vaginal anti-fungals for uncomplicated vaginal candidiasis. The decision to prescribe or recommend the purchase of an anti-fungal for oral or intra-vaginal administration should take into consideration: safety, cost and treatment preference. Unless there is a previous history of adverse reaction to one route of administration or contraindications, women who are purchasing their own treatment should be given full information about the characteristics and costs of treatment to make their own decision. If health services are paying the treatment cost, decision-makers should consider whether the higher cost of some oral anti-fungals is worth the gain in convenience, if this is the patient's preference.
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Affiliation(s)
- M Nurbhai
- Ottawa Health Research Institute, ASB Box 693, Rm 2-006, 1053 Carling Avenue, Ottawa, Ontario, Canada, K1Y 4 E9.
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Abstract
Despite therapeutic advances, vulvovaginal candidosis remains a common problem worldwide, affecting all strata of society. Understanding of anti-candida host defence mechanisms in the vagina has developed slowly and, despite a growing list of recognised risk factors, a fundamental grasp of pathogenic mechanisms continues to elude us. The absence of rapid, simple, and inexpensive diagnostic tests continues to result in both overdiagnosis and underdiagnosis of vulvovaginal candidosis. I review the epidemiology and pathogenesis of this infection, and also discuss management strategies.
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Affiliation(s)
- Jack D Sobel
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
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Menon S, Izquierdo A, Rosen M, Hummel A, Barnhart K. The Effect of Ambulation on Vaginal Distribution of Miconazole Nitrate (1200 mg). J Womens Health (Larchmt) 2007; 16:703-6. [PMID: 17627405 DOI: 10.1089/jwh.2006.0163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the effect activity has on the vaginal distribution of a 1200 mg miconazole nitrate gelatin encapsulated insert, an antifungal agent commonly used to treat vaginal vulvocandidiasis. METHOD Nine subjects underwent two sessions of serial magnetic resonance imaging after insertion of the insert. One session required that the subjects ambulate between images; the other session required the subjects remain supine between images. Vaginal distribution of the insert was quantified by calculating surface contact and linear distance in every image. Comparison of spread was then done between images taken in active subjects and images taken in resting subjects. Time until capsule dissolution was also compared between the two groups. RESULTS No statistically significant difference was seen in spread of insert between the active and resting group. Activity also had no significant effect on capsule dissolution. CONCLUSION Activity does not appear to hinder the spread of the insert, suggesting that this medication can be used daytime or nighttime.
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Affiliation(s)
- Seema Menon
- Reproductive Research Unit, Penn Fertility Care, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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González GM, Robledo E, Saldívar D, González G, Bosques F, Garza E. Therapeutic efficacy of posaconazole against isolates ofCandida albicanswith different susceptibilities to fluconazole in a vaginal model. Med Mycol 2007; 45:221-4. [PMID: 17464843 DOI: 10.1080/13693780601164298] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
A battery of 34 vaginal isolates of Candida albicans was tested against posaconazole (POS) and fluconazole (FLU) to determine their in vitro susceptibilities and to obtain FLU-susceptible and FLU-resistant strains for the murine in vivo studies. FLU-resistant strains were chosen on the basis of their 48-h MICs. The 48-h geometric mean MICs for all isolates tested were 0.016 and 0.656 microg/ml for POS and FLU, respectively. The treatment regimens for the vaginal murine infection model were POS or FLU at 10 or 20 mg/kg of body weight/day and 20 mg/kg twice a day. All regimens with POS were effective in reducing fungal burden of both the fluconazole-susceptible and resistant isolates of C. albicans. All FLU regimens were effective against infection induced by the fluconazole-susceptible strain. While FLU at 10 mg/kg was ineffective against fungal burden of the resistant strain, treatment with FLU at 20 mg/kg once or twice a day was effective against this strain. Both POS and FLU at 20 mg/kg twice a day were able to clear C. albicans from vaginas of mice infected with the fluconazole-susceptible strain. POS displayed a more effective in vivo activity than FLU in the treatment of murine C. albicans vaginitis produced by isolates with different susceptibilities to FLU.
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Affiliation(s)
- Gloria M González
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, México.
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Abstract
Physicians not used to caring for pregnant patients may feel uncomfortable dealing with the many routine problems that can occur during a pregnancy. Other than true obstetric emergencies, which are usually cared for by obstetricians and family physicians, and the common problems of pregnancy can often be cared for by any primary care physician. Given the litigious nature of our society, especially in the realm of obstetrics, it does behoove the physician caring for pregnant women to be aware of the standards of care. When in doubt, it would be prudent to consult with a physician that routinely provides care to pregnant women.
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Affiliation(s)
- Kevin S Ferentz
- Department of Family Medicine, University of Maryland School of Medicine, 29 South Paca Street, Baltimore, MD 21201, USA
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