Comparing the effects of Mycozin and Clotrimazole 1% creams on vaginal candidiasis: a triple-blinded randomized controlled trial

Clotrimazole 1% and Mycozin vaginal cream have been reported to be effective in relieving the symptoms of vulvovaginitis caused by Candida. The resistance to azole compounds, and the side effects of chemical drugs have been reported following azole therapy. It was hypothesized that Mycozin is at least as effective as Clotrimazole in treating vaginal candidiasis. This equivalent, triple-blinded, randomized clinical trial was conducted on 126 patients who complained of vaginal itching referred to Al-Zahra Teaching Hospital, Tabriz, Iran between September 2023 and May 2024. Participants were divided into two groups, i.e., Mycozin (n = 64) and Clotrimazole 1% (n = 62), using the block randomization method. The patient's complaints, clinical signs, the pH and culture of the secretions was recorded before and after treatment. The patient's improvement, level of satisfaction, and side effects were recorded. The data were analyzed using Pearson chi-square test, ANCOVA, and Mann-Whitney U test. There was no statistically significant difference between the two groups regarding the mean pH (Adjusted mean difference: 0.01; 95% Confidence Interval (CI): -0.20 to 0.21, P = 0.965), and microscopic evaluation (Odds Ratio (OR): 0.61; 95% CI; 0.28 to 1.36, P = 0.230). After the treatment the frequency of itching in the Clotrimazole group (N = 13; 22.0%) was lower than that of the Mycozin group (N = 26; 43.3%) (OR: 0.37; 95% CI: 0.17 to 0.82; P = 0.013). There was no statistically significant difference in other symptoms and signs before and after the treatment (P > 0.05). Also, there was no statistically significant difference between the two groups in the level of satisfaction (P = 0.056) and patient improvement (P = 0.074). The side effects of treatment with Mycozin and Clotrimazole were observed in eleven and five patients, respectively. Considering the efficacy of Mycozin vaginal cream in eliminating most of the symptoms and signs associated with vaginal candidiasis and its positive effect in negating the results of culture, it can be used as a suitable alternative in the treatment of vaginal candidiasis in patients interested in herbal medicines and resistant to azole compounds.Trial registration: Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N77. Date of registration: 20/05/2023; URL: https://irct.behdasht.gov.ir/user/trial/68718/view ; Date of first registration: 31/05/2023.

Investigation of Antioxidant, Antifungal, Antibacterial, and Anti-inflammatory Effects of Teucrium polium on Common Pathogens in Vaginitis: A Review

Context: Pathological vaginal discharges are one of the most common reasons for referring to gynecological clinics. The use of herbal medicines has been considered as an effective and low-complication treatment method in recent years. In this study, we introduce Teucrium polium according to traditional Persian medicine and modern medicine’s point of view to investigate the antifungal, antibacterial, and anti-inflammatory effects of T. polium on common pathogens in vaginitis. Evidence Acquisition: This study is a simple review based on studies conducted in PubMed, Google Scholar, SID, and Scopus databases, from October 1984 to June 2019. Finally, 58 articles were selected from 88 for the final review. Results: The results indicate that T. polium is a potential source of antifungal, antibacterial, anti-inflammatory, and antioxidant in producing plant products for vaginal infections treatment thanks to its flavonoid compounds, sesquiterpenes, α-pinene, and linalool. Conclusions: Teucrium polium can be considered as a potential source for vaginal infection treatments. Much clinical research has not been conducted on its use in vaginal infection treatment, so it is recommended to conduct more clinical trials to prove the T. polium’s efficiency against common microorganisms in vaginitis and its treatment.

Vulvovaginal candidiasis: An overview of mycological, clinical, and immunological aspects

AIM

To provide an overview of clinical, immunological, and mycological aspects of vulvovaginal candidiasis (VVC).

METHODS

A literature search was conducted to find relevant articles about different aspects of VVC. Related data from retrieved articles were summarized in different headings.

RESULTS

VVC has a global distribution and Candida albicans is the leading cause of infection except for specific patient groups like postmenopausal, diabetic, or immunocompromised women. VVC has a range of clinical presentations, accordingly, its diagnosis should be based on clinical examination coupled with laboratory investigations. The best therapeutic regimen depends on the patient's conditions and the causative agent. Moreover, factors like drug resistance of the causative agents and different mutations in the immunity-related genes could affect the treatment outcome.

CONCLUSION

As a globally distributed disease, VVC needs further attention, especially in areas related to the treatment failure and recurrence of the disease.

Neuroprotective effects of garlic extract on dopaminergic neurons of substantia nigra in a rat model of Parkinson's disease: motor and non-motor outcomes

Parkinson's disease (PD) is a common and severe neurodegenerative disorder associated with a selective loss of dopaminergic neurons in substantia nigra pars compacta. The crucial role of oxidative stress and inflammation in PD onset and progression is evident. It has been proven that garlic extract (GE) protects the cells from oxidative stress, inflammation, mitochondrial dysfunction and apoptosis. That is, we aimed to investigate if GE reveals protective features on the preclinical model of PD. The study has been designed to evaluate both preventive (GE administered before 6-OHDA injection) and therapeutic (GE administered after 6-OHDA injection) effects of GE on the animal model. Forty male Wistar rats were divided into 4 groups including control, lesion, treatment I (received GE before 6-OHDA injection) and treatment II (received GE both before and after 6-OHDA injection). At the end of treatment, hanging, rotarod, open field and passive avoidance tests as well as immunohistochemistry were performed to evaluate the neuroprotective effects of garlic against PD. Our immunohistochemistry analysis revealed that the tyrosine hydroxylase positive cells (TH+) in GE treated groups were significantly higher (p˂0.001) than the lesion group. The motor deficiency significantly improved in hanging, rotarod, open-field and apomorphine-induced rotational tests. We observed an attenuation in memory impairment induced by PD on GE treated group. Therefore, we found that GE protects dopaminergic neurons in 6-OHDA-induced neurotoxicity and ameliorates movement disorders and behavioral deficits.

Comparison of the effectiveness of and clotrimazole vaginal creams for the treatment of vulvovaginal candidiasis

Candidal vaginitis has a relatively high prevalence, and its resistance to treatment is on the rise. Considering the complications of chemical drugs, the use of herbal medicines has now been favored due to the lack of changes in the normal vaginal flora. The aim of this study was to compare the effectiveness of Satureja khuzestanica and clotrimazole vaginal creams for the treatment of candidal vulvovaginitis. A randomized clinical trial was conducted on 84 reproductive-aged women in the city of Ahvaz, Iran. Individuals were randomly divided into two treatment groups: 1% Satureja khuzestanica vaginal creams (n=42) and 1% clotrimazole vaginal cream (n=42) who used a one-full applicator daily for one week. About 4-7 days after the end of treatment, a clinical examination and laboratory re-tests were performed to determine the level of treatment. The data were analyzed using the Mann-Whitney U, t-test and Chi-square tests, with SPSS version 22. After the treatment, no significant difference was observed between the two groups in terms of vaginal discharge (p = 0.32), vaginal itching (p = 0.26), dysuria (p = 0.99) and dyspareunia (p = 0.60). Moreover, the results of culture (p = 0.62) and smear (p = 0.58) were not statistically significant in the two groups. Also, there was no significant difference between the two groups in terms of complete recovery after the treatment (p = 0.35). Satureja khuzestanica seems to have the same effect as clotrimazole in improving the symptoms of vaginal candidiasis, the negative results of culture and smear, as well as complete treatment.

The effect of Achillea Millefolium L. on vulvovaginal candidiasis compared with clotrimazole: A randomized controlled trial

INTRODUCTION

Vulvovaginal candidiasis is the second most common cause of vulvovaginal infections. The aim of this study is to evaluate the effectiveness of vaginal cream of Achillea millefolium extract in women with vulvovaginal candidiasis in comparison with vaginal clotrimazole.

MATERIALS AND METHODS

This double-blind randomized clinical trial study was conducted on 80 women diagnosed with vulvovaginal candidiasis clinically and by laboratory test; 40 women received vaginal cream clotrimazole 1 % and 40 received vaginal cream containing the aqueous extract of A. millefolium for 7 days. Clinical and laboratory assessments were performed before and after the intervention. Minimum inhibitory concentration of the extract was evaluated with Broth micro-dilution procedure.

RESULTS

The Dermatology life quality index score showed significant reduction in both groups after treatment, but it was significantly more reduced in control group (p < 0.05). Improvement in vulvar erythema was observed in both groups with no statistically difference (p = 0.1). Vaginal culture was negative in term of Candida in 28(77 %) patients of control group and in 18(53 %) patient of experimental group (p < 0.05). The Minimum inhibitory concentration of the extract was 37.5 mg/mL for the standard strain.

DISCUSSION AND CONCLUSION

Study results showed that vaginal cream containing A. millefolium could reduce the complaints of vulvovaginal candidiasis. But, future studies with a larger sample size and different dosages are recommended to assess the outcomes of this new treatment.

The effect of a vaginal suppository formulation of dill (Anethum graveolens) in comparison to clotrimazole vaginal tablet on the treatment of vulvovaginal candidiasis

The goal of this study was to compare the effect of Anethum graveolens (dill) vaginal suppositories and 100 mg clotrimazole vaginal tablets on vulvovaginal Candidiasis. This study was a single centre, single-blind, randomised, placebo-controlled trial, in which 60 women with microbiology-confirmed vulvovaginal candidiasis were randomly assigned to dill and clotrimazole groups. At the end of the study, the estimated prevalence of leucorrhoea, burning, and itching was 23%, 23% and 20% in dill users, respectively. This figure was 20%, 10% and 16.7% for the clotrimazole group, respectively. The difference between the two groups was not significant. 13% of suppository patients, compared with 10% of clotrimazole-treatment patients, had a positive culture, which was not significant (p = .68). According to findings, 2% dill vaginal suppositories were as effective as clotrimazole vaginal tablets in reducing both clinical and microbiological symptoms of Candidiasis. Studies with larger sample sizes are required to confirm current findings. Impact statement What is already known on the subject? Based on results from in vivo and in vitro animal studies, dill (Anethum graveolens) has anti-candida activity. What do the results of this study add? It appears that 2% dill vaginal suppositories were as effective as 100 mg clotrimazole vaginal tablets in reducing both the clinical and microbiological symptoms. What are the implications of these findings for clinical practice and further research? Obstetricians and gynaecologists can offer dill as a useful alternative to chemical drugs, especially in women who are often interested in herbal medicine, or in women who are resistant or are not allowed to use antifungal drugs.