Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush)

Nurbhai, M.; Grimshaw, Jeremy; Watson, Margaret; Bond, Christine; Mollison, Jill; Ludbrook, Anne

doi:10.1002/14651858.cd002845.pub2

Cited by 49 publications

(51 citation statements)

References 24 publications

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“…91 In a Cochrane meta-analysis of 19 trials that assessed the effect of antifungal treatments on uncomplicated VVC, short-course intravaginal treatment with an imidazole or triazole (in a cream, ointment, or suppository formulation) resulted in efficacy comparable with that of an oral azole. 92 The majority of patients (80%-90%) with uncomplicated VVC will achieve symptom relief and negative culture results after completing a standard, short course of antifungal treatment. 91 The ability to treat VVC with a short course of an antifungal agent is based on the pharmacokinetics of these agents.…”

Section: Acute Symptomatic Vaginitis In Women With Diabetesmentioning

confidence: 99%

“…Multiple clinical trials suggest that patients prefer oral to intravaginal treatment. 92 Potential systemic toxicity (primarily headache and gastrointestinal intolerance; rarely abnormal transaminase level elevations) and drug interactions are infrequently associated with orally administered azoles. Azoles, when taken by mouth, inhibit cytochrome P450 (CYP) 2C9 and, to a lesser extent, CYP3A4, thereby decreasing the metabolism and increasing the concentration of other drugs metabolized by these isozymes.…”

Section: Acute Symptomatic Vaginitis In Women With Diabetesmentioning

confidence: 99%

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Genital Mycotic Infections in Patients With Diabetes

Nyirjesy

Sobel

2013

Postgraduate Medicine

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Patients with diabetes, especially those with poorly controlled glycemia, are prone to developing genital mycotic infections-vulvovaginal candidiasis in women and Candida balanitis in men-the latter almost exclusively in uncircumcised men. Candida albicans is the most common pathogen causing balanitis and is also the dominant cause of vulvovaginal candidiasis in women with diabetes, although Candida glabrata is a prominent pathogen in women with type 2 diabetes mellitus. Candida glabrata is less virulent but also less susceptible to conventional antifungal treatment. High blood glucose levels promote yeast attachment and growth, and also interfere with immune responses in the host. In uncircumcised men, the moist, warm space underneath the foreskin is thought to promote yeast growth, especially when hygiene is poor. Several other risk factors have been identified that predispose to genital mycotic infections, including antibiotic use, corticosteroid use, immunosuppression, atopy, and, in women only, genetics, pregnancy, estrogen/oral contraceptive use, and select sexual behaviors (eg, orogenital sex). In patients with hyperglycemia, risk is increased for not only incident infection but also for recurrence, underscoring the key role of establishing and maintaining euglycemia in the management of genital mycotic infections in patients with diabetes. In addition to blood glucose control, first-line treatment involves either an antifungal cream/ointment (or suppository for women only) that is applied intravaginally by women and directly to the affected area(s) by men, or oral treatment, which infrequently causes systemic side effects. Antifungal treatment should also be offered to sexual partners of patients with diabetes with a genital mycotic infection if the partner is similarly infected. Given high efficacy rates, follow-up test-of-cure after the completion of treatment is generally unnecessary.

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Section: Acute Symptomatic Vaginitis In Women With Diabetesmentioning

confidence: 99%

Section: Acute Symptomatic Vaginitis In Women With Diabetesmentioning

confidence: 99%

Genital Mycotic Infections in Patients With Diabetes

Nyirjesy

Sobel

2013

Postgraduate Medicine

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“…There is very little difference in the efficacy of all the products available, and the different in vivo efficacies of miconazole, terconazole, itraconazole, butaconazole, econazole or fluconazole are minimal as far as uncomplicated acute infections are concerned [24][25][26] . Oral or vaginal application is not an issue of efficacy but rather of personal preference [27] .…”

Section: Acute Infectionmentioning

confidence: 99%

Management of Recurrent Vulvo-Vaginal Candidosis as a Chronic Illness

Donders

Bellen²,

Mendling

2010

Gynecol Obstet Invest

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For sporadic acute Candida vaginitis, any oral or local antifungal therapy can be used. For women with recurrent vulvo-vaginal candidosis (RVC), on the other hand, such simple approaches are insufficient, regardless of the product chosen. Instead, RVC should be managed as any other chronic disease and requires long-term, prophylactic, suppressive antifungal treatment. A regimen using individualized, decreasing doses of oral fluconazole (the ReCiDiF regimen) was proven to be highly efficient and offered great comfort to the patients. During this regimen, it is crucial that patients are carefully examined by anamnestic, clinical, microscopic and culture-proven absence of Candida. If a relapse occurs, the medication is adjusted and efforts are taken to find a possible triggering factor for the reactivation of the infection. Care has to be taken not to accumulate ‘don’t do’s’, unless the efficiency of a measure has been proven, by trying to eliminate one risk factor at a time for 2 months. Known possible triggers to be kept in mind are (1) antibiotic use, (2) use of specific contraceptives, especially combined contraceptive pills, (3) disturbed glucose metabolism, (4) the use of personal hygienic products, and (5) tight clothing or plastic panty liners. In therapy-resistant cases, non-albicans infection must be ruled out, and alternative therapies should be tried. Boric acid is proven to be efficient in most of these resistant cases, but other non-azoles like amphotericin B, flucytosine, gentian violet, and even caspofungin may have to be tried. As a final remark it has to be said that many patients feel poorly understood and inefficiently managed by many care-givers, increasing their feelings of guilt and sexual inferiority. Therefore, attention has to be given to take the disease seriously, follow strict treatment regimens, and advise precisely and based on individual evidence concerning any possible risk factors for recurrence. In case of therapy-resistant vulvo-vaginitis, reconsider your diagnosis and/or consider referral to specialized therapists.

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“…The recommended first-line therapy for uncomplicated VVC is topical azoles (4,7,25,27,28), unless resistance of the isolate is substantiated or azole hypersensitivity is diagnosed (4,8). Identifying antifungal resistance in vitro is clinically important, but variable host responses to treatment and unpredictable fungal load in the vulvovaginal mucosa (in loco) invariably weaken in vitro with in vivo correlations.…”

mentioning

confidence: 99%

Fenticonazole Activity Measured by the Methods of the European Committee on Antimicrobial Susceptibility Testing and CLSI against 260 Candida Vulvovaginitis Isolates from Two European Regions and Annotations on the Prevalent Genotypes

Antonopoulou

Aoun

Alexopoulos

et al. 2009

Antimicrob Agents Chemother

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The activity of fenticonazole was studied against 260 West and Southeast European vulvovaginal candidiasis isolates, and low MICs were displayed. Fenticonazole was assessed by European Committee on Antimicrobial Susceptibility Testing and CLSI microdilution methods for the first time, and the results showed excellent agreement (97%) and significant interclass correlation coefficient (P < 0.0001). Also, the levels of agreement for the results for itraconazole, fluconazole, and ketoconazole were 84%, 90%, and 98% (P < 0.0001), respectively. Multilocus typing by PCR fingerprinting and subsequent cluster analysis delineated geographically associated alignments for Candida albicans and fluconazole resistance-related clusters for Candida glabrata.

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Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush)

Cited by 49 publications

References 24 publications

Genital Mycotic Infections in Patients With Diabetes

Genital Mycotic Infections in Patients With Diabetes

Management of Recurrent Vulvo-Vaginal Candidosis as a Chronic Illness

Fenticonazole Activity Measured by the Methods of the European Committee on Antimicrobial Susceptibility Testing and CLSI against 260 Candida Vulvovaginitis Isolates from Two European Regions and Annotations on the Prevalent Genotypes

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