Terconazole cream for non-Candida albicans fungal vaginitis: Results of a retrospective analysis

Abstract

Objective: Although it is FDA-approved for use in vulvovaginal candidiasis caused by non-Candida albicans species, terconazole cream has not been been studied in patients with these infections. We sought to assess the clinical and mycological efficacy of terconazole cream in women with non-C. albicans vaginitis.Methods: The records of patients who had received a 7-day course of terconazole cream for culture-proved non-C, albicans vaginitis were reviewed. Data with regard to patient demographics, clinical and mycologic response to therapy within 1 month of treatment, and outcome with other antifungal therapies were analyzed.Results: Twenty-eight patients received terconazole cream for non-C, albicans infections. Three patients did not return for follow-up. The median age was 45 years. Seven (28%) patients were nulliparous. The median duration of symptoms was 3 years. Nine patients (36%) had received terconazole within the 6 months prior to referral. Overall, there were 20 C. glabrata cases, 3 C. parapsilosis, and 2 C. lusitaniae. Fourteen (56%) patients achieved a mycologic cure; 11 (44%) noted a resolution of their symptoms. Prior terconazole use was not associated with treatment failure (P 0.09). Ten failures received boric acid suppositories as subsequent treatment; a cure was effected in 4 (40%). Two of three patients (67%) were eventually cured with flucytosine cream. Five (20 %) patients remained uncured.Conclusions: Terconazole cream may be an appropriate first-line treatment for non C. albicans vaginitis, even in patients who have previously received the drug. Infect. Dis. Obstet. Gynecol. 8:240-243, 2000. (C) 2ooo Wiley-Liss, Inc. KEY WORDS candidiasis; vaginitis; antifungal therapies ungal vaginitis is one of the most common causes of vaginitis. It is estimated that 13 million cases of vulvovaginal candidiasis (VVC) occur in the United States annually. 1,e Although most of these infections are caused by Candida albicans, recent studies show that non-C, albicans species account for a significant proportion of cases referred to subspeciality clinics. In 1986, O'Conner and Sobel 3 found that 21% of 115 women with recurrent VVC had non-C albicans species. Other centers have found 32% of VVC resulting from to non-C. albicans species in Philadelphia, 4 19% in Pavia, Italy, s and 50% in Rome. 6 Although these studies represent diverse populations, it is clear that non-C. albicans are significant pathogens, regardless of geography, and concerns have been raised that infec-

Genital-oral transmission of Candida lusitaniae

“…2,17 Literature data about the therapy of C. lusitaniae infections are conflicting. This yeast is susceptible to terconazole, 3 miconazole 17 and anidulafungin, 22 sometimes resistant to caspofungin 15 and fluconazole 15,22 and always resistant to itraconazole (100% of resistance in the study by Mukasa et al) 11 and amphotericin B. 24,25 As previously mentioned, our patient was successfully treated with miconazole oral gel, while her girlfriend’s VV was treated by her gynecologist with fluconazole (150 mg).…”

“…1,2 To our knowledge, the first case of C. lusitaniae V was reported in 2000. 3 Cases of V, VV and RVV caused by C. lusitaniae are very rare. [4][5][6][7][8][9][10][11][12][13][14] In the study by Richter et al, 6 C. lusitaniae was isolated in one out of 593 vulvovaginal isolates.…”

Genital-oral transmission of Candida lusitaniae

“…2,17 Literature data about the therapy of C. lusitaniae infections are conflicting. This yeast is susceptible to terconazole, 3 miconazole 17 and anidulafungin, 22 sometimes resistant to caspofungin 15 and fluconazole 15,22 and always resistant to itraconazole (100% of resistance in the study by Mukasa et al) 11 and amphotericin B. 24,25 As previously mentioned, our patient was successfully treated with miconazole oral gel, while her girlfriend’s VV was treated by her gynecologist with fluconazole (150 mg).…”

“…1,2 To our knowledge, the first case of C. lusitaniae V was reported in 2000. 3 Cases of V, VV and RVV caused by C. lusitaniae are very rare. [4][5][6][7][8][9][10][11][12][13][14] In the study by Richter et al, 6 C. lusitaniae was isolated in one out of 593 vulvovaginal isolates.…”

Conazoles

“…Terconazole cream gave acceptable clinical results in the treatment in patients with vulvovaginal candidiasis caused by non- C . albicans species with mycological cure rates of 56% [ 69 ]. Terconazole is well tolerated as a topical agent and no irritation was observed when a rabbit eye was treated with a cream containing 0.8% of terconazole [ 70 ].…”

Glycerol and its derivatives as potential C-3 bio-based building blocks for accessing active pharmaceutical ingredients

“…103 Morinidazole can also be used in appendicitis events. Ornidazole ( 109) is available in various European and Asian countries while morinidazole (111) was approved by the China Food and Drug Administration (CFDA) in 2014. 90 Ornidazole (109) can be directly obtained through an acid-catalyzed reaction between epichlorohydrin (12) and nitroimidazole 108.…”

“…90,101,102 Another nitroimidazole antibiotic, ornidazole (109, Fig. 23), is used in the treatment of infections caused by anaerobic bacteria and is itself an intermediate for the synthesis of morinidazole (111). Both 109 and 111 have been found to display broad-spectrum antiparasitic properties in addition to their antibacterial applications.…”

Genital-oral transmission of Candida lusitaniae

“…2,17 Literature data about the therapy of C. lusitaniae infections are conflicting. This yeast is susceptible to terconazole, 3 miconazole 17 and anidulafungin, 22 sometimes resistant to caspofungin 15 and fluconazole 15,22 and always resistant to itraconazole (100% of resistance in the study by Mukasa et al) 11 and amphotericin B. 24,25 As previously mentioned, our patient was successfully treated with miconazole oral gel, while her girlfriend’s VV was treated by her gynecologist with fluconazole (150 mg).…”

“…1,2 To our knowledge, the first case of C. lusitaniae V was reported in 2000. 3 Cases of V, VV and RVV caused by C. lusitaniae are very rare. [4][5][6][7][8][9][10][11][12][13][14] In the study by Richter et al, 6 C. lusitaniae was isolated in one out of 593 vulvovaginal isolates.…”

Conazoles

“…Terconazole cream gave acceptable clinical results in the treatment in patients with vulvovaginal candidiasis caused by non- C . albicans species with mycological cure rates of 56% [ 69 ]. Terconazole is well tolerated as a topical agent and no irritation was observed when a rabbit eye was treated with a cream containing 0.8% of terconazole [ 70 ].…”

Glycerol and its derivatives as potential C-3 bio-based building blocks for accessing active pharmaceutical ingredients

“…103 Morinidazole can also be used in appendicitis events. Ornidazole ( 109) is available in various European and Asian countries while morinidazole (111) was approved by the China Food and Drug Administration (CFDA) in 2014. 90 Ornidazole (109) can be directly obtained through an acid-catalyzed reaction between epichlorohydrin (12) and nitroimidazole 108.…”

“…90,101,102 Another nitroimidazole antibiotic, ornidazole (109, Fig. 23), is used in the treatment of infections caused by anaerobic bacteria and is itself an intermediate for the synthesis of morinidazole (111). Both 109 and 111 have been found to display broad-spectrum antiparasitic properties in addition to their antibacterial applications.…”

Genital-oral transmission of Candida lusitaniae

“…2,17 Literature data about the therapy of C. lusitaniae infections are conflicting. This yeast is susceptible to terconazole, 3 miconazole 17 and anidulafungin, 22 sometimes resistant to caspofungin 15 and fluconazole 15,22 and always resistant to itraconazole (100% of resistance in the study by Mukasa et al) 11 and amphotericin B. 24,25 As previously mentioned, our patient was successfully treated with miconazole oral gel, while her girlfriend’s VV was treated by her gynecologist with fluconazole (150 mg).…”

“…1,2 To our knowledge, the first case of C. lusitaniae V was reported in 2000. 3 Cases of V, VV and RVV caused by C. lusitaniae are very rare. [4][5][6][7][8][9][10][11][12][13][14] In the study by Richter et al, 6 C. lusitaniae was isolated in one out of 593 vulvovaginal isolates.…”

Conazoles

“…Terconazole cream gave acceptable clinical results in the treatment in patients with vulvovaginal candidiasis caused by non- C . albicans species with mycological cure rates of 56% [ 69 ]. Terconazole is well tolerated as a topical agent and no irritation was observed when a rabbit eye was treated with a cream containing 0.8% of terconazole [ 70 ].…”

Glycerol and its derivatives as potential C-3 bio-based building blocks for accessing active pharmaceutical ingredients

“…103 Morinidazole can also be used in appendicitis events. Ornidazole ( 109) is available in various European and Asian countries while morinidazole (111) was approved by the China Food and Drug Administration (CFDA) in 2014. 90 Ornidazole (109) can be directly obtained through an acid-catalyzed reaction between epichlorohydrin (12) and nitroimidazole 108.…”

“…90,101,102 Another nitroimidazole antibiotic, ornidazole (109, Fig. 23), is used in the treatment of infections caused by anaerobic bacteria and is itself an intermediate for the synthesis of morinidazole (111). Both 109 and 111 have been found to display broad-spectrum antiparasitic properties in addition to their antibacterial applications.…”