Effects of minocycline and tetracycline on the vaginal yeast flora

Inhibitory action of antibiotics on Kluyveromyces marxianus

A bioassay containing Kluyveromyces marxianus in microtiter plates was used to determine the inhibitory action of 28 antibiotics (aminoglycosides, beta-lactams, macrolides, quinolones, tetracyclines and sulfonamides) against this yeast in whey. For this purpose, the dose-response curve for each antibiotic was constructed using 16 replicates of 12 different concentrations of the antibiotic. The plates were incubated at 40°C until the negative samples exhibited their indicator (5-7h). Subsequently, the absorbances of the yeast cells in each plate were measured by the turbidimetric method (λ=600nm) and the logistic regression model was applied. The concentrations causing 10% (IC10) and 50% (IC50) of growth inhibition of the yeast were calculated. The results allowed to conclude that whey contaminated with cephalosporins, quinolones and tetracyclines at levels close to the Maximum Residue Limits inhibits the growth of K. marxianus. Therefore, previous inactivation treatments should be implemented in order to re-use this contaminated whey by fermentation with K. marxianus.

A Review of Systemic Minocycline Side Effects and Topical Minocycline as a Safer Alternative for Treating Acne and Rosacea

Resistance of Cutibacterium acnes to topical antibiotics historically used to treat acne (topical erythromycin and clindamycin and, more recently, topical azithromycin and clarithromycin) has been steadily increasing and new topical antibiotics are needed. Minocycline is a semisynthetic tetracycline-derived antibiotic currently used systemically to treat a wide range of infections caused by Gram-negative and Gram-positive bacteria. In addition to its antibiotic activity, minocycline possesses anti-inflammatory properties, such as the downregulation of proinflammatory cytokine production, suppression of neutrophil chemotaxis, activation of superoxide dismutase, and inhibition of phagocytosis, among others. These characteristics make minocycline a valuable agent for treatment of dermatological diseases such as acne vulgaris and papulopustular rosacea. However, more frequent or serious adverse effects have been observed upon the systemic administration of minocycline than with other tetracyclines. Examples of serious adverse effects include hypersensitivity syndrome reaction, drug-induced lupus, idiopathic intracranial hypertension, and other autoimmune syndromes that may cause death. Here, we review adverse effects and drug–drug interactions observed with oral administration of minocycline and contrast this with topical minocycline formulations recently approved or under development for effectively treating dermatological disorders with fewer adverse effects and less drug interaction.

Vulvovaginitis Caused by Candida Species Following Antibiotic Exposure

PURPOSE OF REVIEW

Goal was to review epidemiology, pathophysiology, and prevention of post-antibiotic Candida vulvovaginitis (VVC).

RECENT FINDINGS

Antibacterial therapy, whether systemic or locally applied to the vagina, represents the single most frequent and predictable cause or triggering mechanism of symptomatic vulvovaginal candidiasis (VVC). Such initiating mechanisms may precipitate sporadic or recurrent episodes of VVC. In spite of this widely recognized association, the exact mechanism whereby antibiotics of all classes cause acute exacerbation of symptomatic vaginal disease remains largely unstudied and therefore largely unknown. Pathophysiology is hypothesized to be reduction or alteration of vaginal microbiome restraints of yeast colonization, proliferation, and expression of virulence characteristics. The predictable link between antibiotic use and post-antibiotic VVC affords practitioners an opportunity for timely intervention using selective, convenient antimycotics usually drugs but possibly probiotic measures. Indications and limitation of these steps are discussed.

RISK FACTORS OF VULVOVAGINAL CANDIDIASIS IN DERMATO-VENEREOLOGY OUTPATIENTS CLINIC OF SOETOMO GENERAL HOSPITAL, SURABAYA, INDONESIA

BACKGROUND

Vulvovaginal Candidiasis (VVC) is one-third of vaginitis case. About 75% of women will have at least one episode of VVC. Complication of VVC can be unfavorable to impact the patient's quality of life. Knowing its risk factors can prevent someone suffering from pathological VVC and its sequelae. The purpose of this study was to identify risk factors of VVC.

MATERIALS AND METHODS

A descriptive retrospective study was conducted by total sampling to 213 medical records of VVC patients from 869 fluor albus patients in Sexually Transmitted Infection (STI) Division, Dermatology and Venereology Outpatient Clinic in Dr. Soetomo General Hospital, Surabaya, East-Java, Indonesia in 2011 to 2013.

RESULTS

In 2011, 69 cases (22.77%) from 303 fluor albus patients, in 2012 69 cases (22.69%) from 304 fluor albus patients, and in 2013 75 cases (28.63%) from 262 fluor albus patients. As many as 180 (84.50%) of the patients were sexually active age group, which was 15-44 years old. Mostly patients were married (69.48%). As many as 167 (78.40%) sexual partners were patient's husband. About 95 (44.13%) patients presented with recurrent VVC. Risk factors are previous STIs 74 (34.74%), vaginal douching (27.70%), pre-martial sexual intercourse (5.63%), other STIs (3.29%), diabetes mellitus (2.34%), gestation (1.88%), other fluor albus infections (0.94%), pantyliner (0.47%), and STIs in sexual partner (0,47%).

CONCLUSION

Avoiding and/or managing risk factors is important to prevent VVC and its complications.

Does vaginal douching affect the type of candidal vulvovaginal infection?

The normal vaginal microbiota is a dynamic system that continually fluctuates under the environmental changes and different physiological conditions. Yeast infections of the vagina are caused by one of the species of fungus called Candida (C.). The study aimed to evaluate the types of mycobiota in women with vulvovaginal candidiasis (VVC) who were performing vaginal douching (VD) or not. Furthermore, it studied the antifungal sensitivity toward different fungi isolated from the vagina. In a cross-sectional study conducted in Assiut University Hospital, Egypt, women with VVC were interviewed regarding relevant history including the habit of VD. Vaginal swabs were obtained and processed by direct microscope and by culture on CHROMagar Candida and other differential media. The types of Candida in women with the habit of VD were compared with those not having this habit. We found that VD habit was practiced by 67.4% of women with VVC, and Candida albicans was the commonest (78.3%) type observed. There was no significant difference in the percentage of non-albicans types between women performing VD (23.6%) and those not reporting this habit (18.9%). Harboring non-albicans types were significantly increased in regular performers of VD compared with those who had this procedure only after sexual intercourse or after the end of menstruation (36.8%,12.5%, and 16.7%, respectively) (P = .048). Thus, vaginal douching does not influence the type of Candida infection involved in VVC. Frequent performance of VD increases the likelihood of having non-albicans types and the resistance to the common antifungal agents.

Doxycycline for malaria chemoprophylaxis and treatment: report from the CDC expert meeting on malaria chemoprophylaxis

Doxycycline, a synthetically derived tetracycline, is a partially efficacious causal prophylactic (liver stage of Plasmodium) drug and a slow acting blood schizontocidal agent highly effective for the prevention of malaria. When used in conjunction with a fast acting schizontocidal agent, it is also highly effective for malaria treatment. Doxycycline is especially useful as a prophylaxis in areas with chloroquine and multidrug-resistant Plasmodium falciparum malaria. Although not recommended for pregnant women and children < 8 years of age, severe adverse events are rarely reported for doxycycline. This report examines the evidence behind current recommendations for the use of doxycycline for malaria and summarizes the available literature on its safety and tolerability.

Minocycline in acne vulgaris: benefits and risks

Minocycline is a semi-synthetic, second-generation tetracycline. It was introduced in 1972 and has both antibacterial and anti-inflammatory properties. Minocycline is used for a variety of infectious diseases and in acne. Even today, new indications beyond the antibacterial indications are being investigated such as its use in neurologic diseases. Formerly, minocycline was thought to have a superior efficacy in the treatment of inflammatory acne, especially with respect to antibacterial-resistant Propionibacterium acnes. A thorough review of the literature, however, shows that minocycline is not more effective in acne than other tetracyclines. Compared with first-generation tetracyclines, minocycline has a better pharmacokinetic profile, and compared with doxycycline it is not phototoxic. However, minocycline has an increased risk of severe adverse effects compared with other tetracyclines. It may induce hypersensitivity reactions affecting the liver, lung, kidneys, or multiple organs (Drug Reaction with Eosinophilia and Systemic Symptoms [DRESS] syndrome) in the first weeks of treatment and, with long-term treatment, may cause autoimmune reactions (systemic lupus erythematosus, autoimmune hepatitis). In addition, CNS symptoms, such as dizziness, are more frequent compared with other tetracyclines. Long-term treatment may induce hyperpigmentation of the skin or other organs. Resistance of P. acnes to minocycline also occurs, dependent on the prescribing behavior. Considering the aspects of efficacy, its adverse effect profile, resistance, price, and alternatives, minocycline is no longer considered the first-line antibacterial in the treatment of acne.

Effect of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 on the ability of Candida albicans to infect cells and induce inflammation

Vulvovaginal candidiasis, a high prevailing infection worldwide, is mainly caused by Candida albicans. Probiotic Lactobacillus reuteri RC-14 and Lactobacillus rhamnosus GR-1 have been previously shown to be useful as adjuvants in the treatment of women with VVC. In order to demonstrate and better understand the anti-Candida activity of the probiotic microorganisms in an in vitro model simulating vaginal candidiasis, a human vaginal epithelial cell line (VK2/E6E7) was infected with C.albicans 3153a and then challenged with probiotic L. rhamnosus GR-1 and/or L. reuteri RC-14 or their respective CFS (alone or in combination). At each time point (0, 6, 12 and 24 hr), numbers of yeast, lactobacilli and viable VK2/E6E7 cells were determined and, at 0, 6 and 12 hr, the supernatants were measured for cytokine levels. We found that C. albicans induced a significant increase in IL-1alpha and IL-8 production by VK2/E6E7 cells. After lactobacilli challenge, epithelial cells did not alter IL-6, IL-1alpha, RANTES and VEGF levels. However, CFS from the probiotic microorganisms up-regulated IL-8 and IP-10 levels secreted by VK2/E6E7 cells infected with C. albicans. At 24 hr of co-incubation, L. reuteri RC-14 alone and in combination with L. rhamnosus GR-1 decreased the yeast population recoverable from the cells. In conclusion, L. reuteri RC-14 alone and together with L. rhamnosus GR-1 have the potential to inhibit the yeast growth and their CFS may up-regulate IL-8 and IP-10 secretion by VK2/E6E7 cells, which could possibly have played an important role in helping to clear VVC in vivo.

Tetracycline effects on Candida albicans virulence factors

Object. To determine if tetracycline, previously reported to increase the probability of developing symptomatic vaginal yeast infections, has a direct effect on Candida albicans growth or induction of virulent phenotypes. Method. In vitro, clinical isolates of yeast were cultivated with sublethal concentrations of tetracycline and yeast cell counts, hyphal formation, drug efflux pump activity, biofilm production, and hemolysin production were determined by previously reported methods. Results. Tetracycline concentrations above 150 μg/mL inhibited Candida albicans, but at submicrogram/mL, a modest growth increase during the early hours of the growth curve was observed. Tetracycline did not inhibit hyphal formation at sublethal concentrations. Hypha formation appeared augmented by exposure to tetracycline in the presence of chemically defined medium and especially in the presence of human serum. Efflux pump CDR1 was upregulated and a nonsignificant trend toward increased biofilm formation was noted. Conclusion. Tetracycline appears to have a small growth enhancing effect and may influence virulence through augmentation of hypha formation, and a modest effect on drug efflux and biofilm formation, although tetracycline did not affect hemolysin. It is not clear if the magnitude of the effect is sufficient to attribute vaginitis following tetracycline treatment to direct action of tetracycline on yeast.

Vulvovaginal candidosis

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.

Relationship of fungal vaginitis therapy to prior antibiotic exposure

Objective: To address the putative association of antibiotic use and subsequent yeast vaginitis in a population of non-pregnant women.

Methods: Three hundred and sixteen women who received medical care in rural family medicine clinics enrolled in this study. Participants were pre-menopausal and non-pregnant and were followed until they used a course of antifungal therapy for vaginitis, became pregnant or moved from the catchment area. At entry subjects were free of vaginitis symptoms and had taken no antibiotics for 30 days. Patients were followed by repeated review of clinic records, hospital records and telephone or personal interviews. Data collection included documentation of episodes of antifungal treatment for vulvovaginal candidiasis and confirmed antibiotic treatment or credible history of antibiotic use prior to the use of antifungal therapy. Physician-reported uses of antibiotic and antifungal as well as patient-reported uses of these were recorded.

Results: There were four reported cases of antifungal therapy following within a month of antibiotic use, in contrast to 484 antibiotic uses not followed by antifungal use. If time of observation was extended to 6 months from antibiotic use, there were 13 uses of antifungal therapy after antibiotics and 475 uses of antibiotics not followed by antifungal therapy.

Conclusion: Our results cast doubt on the association of antibiotics as a putative cause of yeast vulvovaginitis.

Antibiotic-associated vulvovaginal candidiasis

Vulvovaginal candidiasis (VVC) is one of the most common causes of vaginitis, and its incidence has increased markedly during the past three decades. The widespread overuse of antibiotics has been suggested as one of the major factors contributing to the increasing incidence of VVC. However, evidence supporting this association has been limited because few studies with rigorous scientific methodology have been conducted. Moreover, existing data regarding the risk for developing VVC after antibiotic use are conflicting. This review examines the available information in the literature regarding antibiotic-associated VVC, its incidence, and its potential mechanisms. Implications for clinical practice and research are also discussed.

Effects of doxycycline, metronidazole and their combination on Candida species colonization of the human oropharynx, intestinal lumen and vagina

The present study reports about the effect of doxycycline and/or metronidazole on colonization by Candida organisms of the human gastrointestinal (GI), oropharyngeal tract and vagina. Treatment with doxycycline or metronidazole for 10 days increased, but not significantly, the GI, oropharyngeal or vaginal colonization by Candida species. The combination of doxycycline and metronidazole, used for the same period, caused a significant increase of 2.5 log10 CFU/g of stools (mean) colonization by Candida. Likewise, 2 out of 9 patients treated with the combination had substantially increased colonization of their vagina by Candida species. This effect, however, could not be expressed statistically due to the semiquantitative nature of the vaginal cultures. In contrast, the combination did not increase oropharyngeal colonization. In conclusion, doxycycline and metronidazole as monotherapies, did not increase significantly Candida colonization in the cavities examined. The combination of doxycycline and metronidazole had a substantial effect, increasing the GI and vaginal colonization by Candida organisms.

Aspects of fungal pathogenesis in humans

Fungal diseases have become increasingly important in the past few years. Because few fungi are professional pathogens, fungal pathogenic mechanisms tend to be highly complex, arising in large part from adaptations of preexisting characteristics of the organisms' nonparasitic lifestyles. In the past few years, genetic approaches have elucidated many fungal virulence factors, and increasing knowledge of host reactions has also clarified much about fungal diseases. The literature on fungal pathogenesis has grown correspondingly; this review, therefore, will not attempt to provide comprehensive coverage of fungal disease but focuses on properties of the infecting fungus and interactions with the host. These topics have been chosen to make the review most useful to two kinds of readers: fungal geneticists and molecular biologists who are interested in learning about the biological problems posed by infectious diseases, and physicians who want to know the kinds of basic approaches available to study fungal virulence.

Vaginal candidosis: epidemiological and etiological factors

A review is presented of the emerging problem of candidal colonization regarding epidemiological and etiological factors. In recent years a change in epidemiological trends has been observed. Vaginal candidosis seems to show a higher frequency to recur and a significant increase in infections caused by non albicans species of candidas has been stated. The three stage mechanisms of adhesion, blastopore germination and epithelium invasion are emphasized. There is a balance between candidal organisms and vaginal defense factors (lactobacilli, cellular and humoral immunity) controlling and limiting fungal growth. Vaginitis appears because of an increased number or an enhanced virulence of candidas. In some other patients, a decreased vaginal defense mechanism is a determinant factor. There are still a number of factors involved in clinical candidal vulvovaginitis that need to be clarified.

Psychological factors associated with recurrent vaginal candidiasis: a preliminary study

OBJECTIVE

To identify psychological factors associated with chronic recurrent vaginal candidiasis.

DESIGN

A cross sectional exploratory study of women with chronic, recurrent vaginal candidiasis.

PATIENTS

28 women found culture positive and treated for vaginal candidiasis by a clinic physician at least twice within the past 6 months. All women reported that they had experienced vaginal thrush six or more times within 1 year. A comparison group comprised 16 women with no history of recurrent vaginal candidiasis, of similar age range, and recruited from a women's family planning service.

METHODS

Both groups were compared on demographic criteria, sexual health histories, mental health, and psychological health characteristics. A purpose designed structured interview was administered alongside a battery of standardised psychometric instruments measuring mood, satisfaction with life, self esteem, and perceived stress.

RESULTS

The two groups showed considerable similarities, with no significant differences in demographic characteristics and most sexual health issues. However, women with recurrent vaginal candidiasis were significantly more likely to suffer clinical depression, to be less satisfied with life, to have poorer self esteem, and to perceive their lives as more stressful. Additionally, women with recurrent vaginal candidiasis reported that their candidiasis seriously interfered with their sexual and emotional relationships.

CONCLUSIONS

Overall, this study identified many areas of psychological morbidity associated with chronic vaginal candidiasis, and indicates that development of appropriate psychological treatment initiatives in this area is long overdue.

A study of candidosis: the role of fomites

This study investigates treatment failure and recurrences of vulvo-vaginal candidosis. It reviews the factors possibly associated with both. Patients attending a department of genitourinary medicine with recurrent candidosis (N = 186) were entered in the trial. The patients were investigated for evidence of candidosis from vagina, rectal wall and buccal mucosa and were given antifungal therapy. Prevention and reinfection via fomites was studied by means of a single blind parallel study comparing the effect of soaking undergarments in the amphoteric biocide Tego 103G with the effect of a placebo soak. General and possible contributory factors influencing treatment and failure and recurrences were considered. The success rate of miconazole therapy was typical of any imidazole therapy: 85.4%. There was no evidence that modern oral contraceptives played a role in candidosis. Oral nystan reduced the rectal wall carriage from 39.2% to 23.2%. Oral yeast carriage rate in women was 37.6%. The recurrence rate over a six month period was 47.4%. The laboratory results of Tego soaking reduced the yeast carriage on panties from 85.2% to 23.4%. However, no evidence was found in the trial results that panties were a significant source of reinfection.

Vaginal infections in adult women

Often trivialized by the medical profession, vaginitis in adult women is not only extremely common but is the source of considerable distress and often results in marked suffering. Epidemiologic studies described in this article indicate the high prevalence of vaginitis and the large number of causes. Although the majority of infections in women are due to bacterial vaginosis, VVC, and trichomoniasis, it is clear that many other causes exist, and we have yet to discover the etiology of many clinical syndromes. Considerable progress has been made in understanding the pathogenesis of the three common vaginitides. Although excellent progress has been made by the pharmaceutical industry in providing new drugs for vaginitis, any further progress will require a better understanding of etiology and pathogenesis. Vaginitis causes major symptoms and is more than a nuisance problem. Clinicians owe it to their patients to attempt to make an accurate diagnosis and not to rely on empiric therapy.

Superior antibacterial action and reduced incidence of bacterial resistance in minocycline compared to tetracycline-treated acne patients

Twenty-five previously untreated acne patients were monitored throughout a 6-month course of therapy with either tetracycline or minocycline for changes in the numbers of staphylococci, propionibacteria and yeasts of the genus Malessezia on the skin surface. Antibiotic resistant staphylococci and propionibacteria were also counted. Minocycline (50 mg b.d.) produced a 10-fold greater reduction in propionibacterial numbers compared to tetracycline (500 mg b.d.) after 12 (P less than 0.02, t-test) and 24 weeks (P less than 0.05) of therapy. As treatment progressed, propionibacteria were replaced by yeasts, numbers of which were significantly increased by week 12 (P less than 0.02) in tetracycline-treated patients and by week 24 (P less than 0.01) in minocycline-treated patients. This suggests that yeasts have no role in the pathogenesis of acne but may compete with propionibacteria for the same niche. Overgrowth of antibiotic resistant staphylococci prevented any decrease in staphylococcal numbers in tetracycline-treated patients, but minocycline produced a significant and sustained reduction in staphylococcal numbers after 1 week of therapy (P less than 0.001). An increase in the number of multiply resistant (greater than or equal to 3 resistances) staphylococci occurred in 67% of tetracycline-treated and 33% of minocycline-treated patients by the end of the treatment period. There was no evidence of propionibacterial resistance in either treatment group. This study shows that minocycline has much greater antibacterial activity in vivo against both staphylococci and propionibacteria and produces less staphylococcal antibiotic resistance than tetracycline.

Pathogenesis and epidemiology of vulvovaginal candidiasis

In contrast to women with infrequent episodes of candidal vaginitis, women with chronic and recurrent candidal vaginitis do not have recognizable precipitating or causal factors. Analysis of vaginal yeast isolated from women with recurrent candidal vaginitis, although revealing a higher percentage of non-albicans Candida sp., indicates that resistance to imidazoles is not a causal factor, and other fungal virulence factors that could explain the repeated attacks have not been identified. Strain typing of sequential clinical isolates indicates a pattern of vaginal relapse rather than frequent vaginal reinfection, and attempts to reduce attacks by treating sexual partners and suppressing a gastrointestinal tract focus have failed. Recent immunological studies suggest the possibility of an acquired Candida antigen-specific immunological deficiency resulting in uncontrolled vaginal Candida proliferation and hence repeated clinical attacks. In support of the immunological hypothesis is the recent report of normal T lymphocyte suppression of Candida hyphal production.

Epidemiology of vaginal Candida infection: significance of numbers of vaginal yeasts and their biotypes

The prevalence, quantity and biotypes of vaginal yeasts were determined for 1082 randomly selected nonpregnant patients attending two genitourinary medicine clinics. The overall yeast prevalence was 22.1% with a geometric mean of 40 and a median of 75 yeast colonies per positive isolate (on 5-cm Petri dishes). There was no statistically significant variation in prevalence, quantity or biotype of yeasts with the patients' age, season of the year, stage of the menstrual cycle, recent antibiotic history, contraceptive use or main diagnosis (excluding candidosis). A clinical score for Candida infection, based on symptoms of pruritus and signs of Candida vulvovaginitis, showed significant variation with the prevalence and quantity of yeast isolates. Unequivocal clinical evidence of candidosis was strongly associated with high concentrations of vaginal yeasts. There was also some association between certain groups of Candida albicans biotypes and the clinical score. These observations reemphasize the need for consideration of both clinical and mycological factors in establishing a diagnosis of vulvovaginal Candida infection. It is suggested that isolation of fewer than 10 yeast colonies from a vaginal swab is usually unlikely to indicate an infection requiring treatment.

Epidemiology and pathogenesis of recurrent vulvovaginal candidiasis

Millions of women worldwide continue to suffer from vulvovaginal candidiasis, which is second only to anaerobic bacterial vaginosis in the United States. Evidence is presented of an increasing incidence of vulvovaginal candidiasis, the cause of which is unclear, but this increase is probably the result of multiple factors including widespread abuse of antibiotics, possibly oral contraceptives, and most important inadequate vaginal therapy. Some women never experience vulvovaginal candidiasis, others have infrequent episodes, and a third subpopulation have recurrent episodes resulting in considerable morbidity and suffering. Two fundamental questions face investigators: the mechanism whereby asymptomatic colonization converts to symptomatic disease and the elusive explanation for frequent recurrences of vulvovaginal candidiasis. Although several factors have been identified as predisposing to recurrent vulvovaginal candidiasis (pregnancy, oral contraceptives, exogenous hormones, antibiotics, diabetes mellitus, etc.), the majority of women with recurrent vulvovaginal candidiasis do not have recognizable predisposing factors. What has emerged over the last few years is the awareness that different pathogenic mechanisms may be operative in individual patients responsible for a spectrum of clinical manifestations. Understanding the pathogenic mechanisms is essential if we are to progress in treatment. In addition to the study of newer antimycotic agents, new strategies of therapy are required and must be individualized for patients with recurrent vulvovaginal candidiasis.