Terbinafine Versus Itraconazole and Fluconazole in the Treatment of Vulvovaginal Candidiasis

Abstract

Vulvovaginal candidiasis is one of the most frequent infections of the female genital tract with a high incidence. Although numerous antimycotical agents are available for treatment of yeast vaginitis, there are few comparative data on the in vivo and in vitro activity of these drugs. The aim of this open, randomized, and comparative study was to determine in vivo and in vitro effectiveness of the 3 systemic antifungal agents: terbinafine and 2 azoles (itraconazole and fluconazole) in the treatment of patients with Vulvovaginal candidiasis. A total of 44 patients who had signs and symptoms of Vulvovaginal candidiasis were recruited for the study. Patients were randomly assigned to 3 groups: terbinafine 500 mg/d orally was used for 7 days, itraconazole 200 mg/d orally was used for 7 days, and fluconazole 150 mg orally was used as a single dose. Both clinical and mycologic examinations were performed for posttreatment assessment at week 4. This study revealed a clinical cure rate 33.3% for terbinafine, 60% for itraconazole, and 66.6% for fluconazole (P>0.05). Mycologic cure rates were 33.3%, 10%, and 66.6% respectively (P<0.05). Overall cure rates were 33.3%, 10%, and 53.3% (P>0.05). Terbinafine could be an alternative treatment option in Vulvovaginal candidiasis because there were no significant differences in the clinical and overall cure rates among 3 antifungal agents. However, terbinafine could not be suggested as a first-line treatment in Vulvovaginal candidiasis. Systemic use of terbinafine in larger numbers of cases may give more information about the effectiveness of this drug in the treatment of patients with vulvovaginal candidiasis.

Molecular identification and antifungal susceptibility of 186 Candida isolates from vulvovaginal candidiasis in southern China

“…Oral or topical terbinafine achieved good results in two small sample clinical observations (Ferahbas et al, 2006;Mahmoudabadi et al, 2013). Nevertheless, although it was found less active against vaginal isolates of C. albicans (Gamarra et al, 2014), 74.7 % of C. albicans strains were resistant to terbinafine in the present study.…”

The significance of itraconazole for treatment of fungal infections of skin, nails and mucous membranes

“…In the treatment of vulvovaginal candidiasis a three‐day (200 mg itraconazole daily for 3 days) as well as a one‐day treatment regimen (200 mg itraconazole twice on one day) shows good clinical efficacy [62, 63]. An open randomized comparative study on 44 women with vulvovaginal candidiasis showed that the three systemic antifungal agents itaconazole (200 mg daily for 7 days), fluconazole (150 mg as a single dose) and terbinafine (500 mg daily for 7 days) did not differ significantly with regards to clinical and mycological cure rates four weeks after the start of treatment [64]. A randomized double‐blind study on 86 women with acute vulvovaginal candidiasis showed similar results.…”

Antifungal drug resistance pattern of Candida. spp isolated from vaginitis in Ilam-Iran during 2013-2014

“…Some important factors which cause Candidiasis to increase are pregnancy, contraception drugs with high estrogen, antibiotic consumptions, uncontrolled diabetes, immuno-suppressive drugs, unsafe or excessive sexual intercourse, chronic anemia and season allergic [ 23 – 26 ]. For treating Candidal vaginitis, the most available way is using local azol family such as clotrimazole [ 27 ]. The most abundant use of nystatin is the treatment of facial infections such as mucosal candidiasis including vaginal or gastrointestinal infections [ 28 ].…”

“…Other members of topical azol family are butoconazole, miconazole and terconazole. The fluconazole and ketoconazole are used orally and has the same effect [ 27 – 29 ]. However, resistance to azol in Candida species has been increasing in recent years and has caused serious problems in successful treatment of vaginitis.…”