Itraconazole is a new orally active triazole antifungal agent with enhanced activity against Candida species. In the clinical trial described in this paper, we compared the efficacy and safety of itraconazole capsules with those of clotrimazole vaginal tablets and placebo oral capsules for women with acute vulvovaginal candidiasis. Ninety-five patients were randomized in a 2:1:1 fashion to

~~ ~ ~The hormonal milieu can alter susceptibility to infection. The effect of hormones on Trichomonas vaginalis was studied utilizing axenically cultured clinical isolates. Oestrogens, in physiological concentrations, decreased the growth of the organisms and their attachment to mammalian cells in vitro, and acted as a chemorepellent. The specificity of these effects was verified by their being blocked with anti-oestrogens, by the dose-and time-dependency of the responses, and by the lack of effect with other hormones. These results suggest that oestrogens may decrease the virulence of T. vaginalis; however, interactions between oestrogens and mammalian cells may promote the development of infection. Thus complicated interactions between hormones, micro-organisms and mammalian cells must determine whether exposure to oestrogens predisposes to or prevents the development of infection.

Fluconazole is a new oral triazole antifungal with good activity against Candida spp. In this study, we investigated the effectiveness and tolerability of a three-day course of treatment with fluconazole compared with clotrimazole vaginal tablets in nonpregnant women with acute Candida vaginitis. Of the 90 evaluable patients who received fluconazole, 76 (84 percent) were asymptomatic seven to ten days after treatment compared with 84 of 95 (88 percent) treated with clotrimazole. An additional ten patients in the fluconazole group (11 percent) and seven in the clotrimazole group (7 percent) had improvement in their signs and symptoms. Only four patients in each group (4 percent) were considered treatment failures. Mycological cures were obtained in 89 and 93 percent of patients treated with fluconazole and clotrimazole, respectively, seven to ten days posttreatment. Clinical cure rates remained high one month posttreatment: 79 percent in the fluconazole group and 83 percent in the clotrimazole group. Both therapies were well tolerated. One patient discontinued treatment after she developed diarrhea while receiving fluconazole. The most common adverse effects associated with fluconazole use were nausea (six percent) and diarrhea (three percent). No clinically significant laboratory abnormalities were observed. In this investigation, oral fluconazole therapy was found to be as safe and effective as clotrimazole vaginal tablets in women with acute vulvovaginal candidiasis.

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Because an endogenous phospholipase C (PLC) participates in neutrophil activation and because many bacterial pathogens produce PLCs, these studies examined the effect of PLC from Bacillus cereus on the release of the granule enzyme lysozyme from human neutrophils. Bacillus cereus PLC caused dose-dependent lysozyme release, and combined stimulation of neutrophils with PLC and fluoride led to increased secretion. Stimulation of neutrophil degranulation is a potential contributing factor for tissue damage in infections caused by PLC-producing organisms.