Hospital formulations for the treatment of non-albicans vulvovaginitis

Abstract

Background As vaginal flucytosine is not commercially available, it is necessary to prepare this formulation in the Pharmacy Department. Purpose To describe the preparation of flucytosine 15.5% (FLUCY15.5), and flucytosine 17% + amphotericin 3% (FLUAM) creams for vaginal use and their efficacy in the treatment of Candida glabrata and Candida tropicalis. Materials and methods FLUCY15.5 was prepared as follows: Twenty-eight 500 mg capsules of flucytosine (Ancotil) were opened into a mortar and the contents crushed. The powder was mixed with glycerine to form a paste. Cold Cream was added up to 90 g. It was blended until smooth. The procedure for preparing FLUAM was: Thirty-one 500 mg capsules of flucytosine were opened into a mortar and the contents crushed. Then 2.7 g of amphotericin B powder were added and mixed with glycerine to create a paste. Acuagel was added to a total weight of 90 g. It was blended until smooth. An expiry date of 14 days was given, although according to the Spanish Pharmacopoeia the stability of these formulations is 3 months. Vaginal applicators were used to apply the cream intravaginally. Results A 36-year-old woman with vulvovaginitis (positive culture for C. glabrata resistant to itraconazole and sensitive to amphotericin B, flucytosine, fluconazole and voriconazole in January 2009), was treated with oral and intravenous fluconazole, vaginal ketoconazole, intravenous voriconazole and vaginal boric acid. However, in February 2009 the culture was still positive. The physician prescribed 5 g/day vaginal FLUCY 15.5 for 14 days. For preparation details see materials and methods. After this treatment, the culture became negative (April 2009). Unfortunately, in March 2010, the patient again developed pain and vaginal itching. Culture of vaginal discharge was positive for C. tropicalis. The physician prescribed 5 g/day vaginal FLUAM and oral fluconazole 50 mg/day for 14 days. It was prepared as indicated above. After this treatment, the culture was negative (April 2010). Conclusions Local treatment with flucytosine and amphotericin B was effective against vaginal infections caused by non-albicans Candida species.

NP-002 Abstract withdrawn

“…Four flucytosine formulations for vaginal application were identified in literature. [5][6][7][8] We compounded flucytosine 15.5% gel by reducing fourteen 500 mg flucytosine tablets to a fine powder in a mortar. The powder was then moistened with 5 mL of glycerin to form a smooth paste, which was then added to 40 g of a lubricating vaginal gel base.…”