Pharmacotherapy of Vulvovaginal Candidiasis According to Pharmacoepidemiology Data and Evidence-Based Medicine

Clinical Microbiology and Antimicrobial Chemotherapy. 2007; 9(1):34-47

​ Mikhailov A.V., Reshetko O.V., Lucevitch K.A.
vulvovaginal candidiasis antifungal therapy efficacy safety
Section
Diseases and Pathogens
Type
Journal article
Publication
Clinical Microbiology and Antimicrobial Chemotherapy. 2007; 9(1):34-47

Abstract

Approximately 75% of women experience at least one episode of acute vulvovaginal candidiasis during their life. In the 1980-90s, almost two-fold increase in fungal vaginitis was observed with increase in number of cases caused by non-albicans strains Candida. Despite the number of available antifungals, rate of treatment failure remains relatively high and lead to spread of the resistant strains and transformation of the disease to the chronic and recurrent forms. Currently, there are no data on clinical equivalence of the original and generic antifungal agents. Adequate clinical trials focused on the clinical efficacy assessment and eradication rates in the treatment with the different antifungals may help to improve the quality of treatment. This paper is an attempt to identify current trends in epidemiology and treatment of vulvovaginal candidiasis according to evidence-based medicine.

  • 1. Marrazzo J. Vulvovaginal candidiasis. Br J Med 2003; 326:993-4.
  • 2. Bingham J.S. What to do with the patient with recurrent vulvovaginal candidiasis. Sex Transm Inf 1999; 75:225-7.
  • 3. Lipsky M.S., Waters T., Sharp L.K. Impact of vaginal antifungal products on utilization of health care services: evidence from physician visits. J Am Board Fam Pract 2000; 13:178-82.
  • 4. Foxman B., Barlow R., D’Arcy H., et al. Candida vaginitis: self-reported incidence and associated costs. Sex Transm Dis 2000; 27:230-5.
  • 5. Романовская Т.А. Современная практика и вопросы стандартизации терапии вульвовагинального кандидоза. Гинекология 2004; 6(1):14-7.
  • 6. Geiger A.M., Foxman B., Gillespie B.W. The epidemiology of vulvovaginal candidiasis among university students. Am J Public Health 1995; 85:1146-8.
  • 7. Sobel J.D., Faro S., Force R.W., et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. Am J Obstet Gynecol 1998; 178:203-11.
  • 8. De Leon E.M., Jacober S.J., Sobel J.D., Foxman B. Prevalence and risk factors for vaginal Candida colonization in women with type 1 and type 2 diabetes. BMC Infect Dis 2002; 2:1.
  • 9. Wilton L., Kollarova M., Heeley E., Shakir S. Relative risk of vaginal candidiasis after use of antibiotics compared with antidepressants in women: postmarketing surveillance data in England. Drug Saf 2003; 26:589-97.
  • 10. Patel D.A., Gillespie B., Sobel J.D., et al. Risk factors for recurrent vulvovaginal candidiasis in women receiving maintenance antifungal therapy: results of a prospective cohort study. Am J Obstet Gynecol 2004; 190:644-53.
  • 11. Farage M.A., Stadler A. Risk factors for recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 2005; 192:981- 2.
  • 12. Орджоникидзе Н.В. Вульвовагинальный кандидоз в акушерской практике. Гинекология 2004; 6(4):189-91.
  • 13. Egen-Lappe V., Hasford J. Drug prescription in pregnancy: analysis of a large statutory sickness fund population. Eur J Clin Pharmacol 2004; 60:659-66.
  • 14. Blaschke-Hellmessen R. Vaginal transmission of Candida and its consequences. Mycoses 1998; 41(Suppl.2):31-6.
  • 15. Герасимова Н.М., Кениксфест Ю.В., Кохан М.М. и соавт. Тактика врача при урогенитальном кандидозе у беременных и кандидозе кожи и слизистых у новорожденных детей (терапевтические и профилактические аспекты). Вестн Дерматол Венерол 2005; 3:68-73.
  • 16. Колбин А.С., Шабалов Н.П., Климко Н.Н. Кандидоз у новорожденных с очень низкой массой тела при рождении. Clinical Microbiology and Antimicrobial Chemotherapy.2005; 7:189-96.
  • 17. King C.T., Rogers P.D., Cleary J.D., Chapman S.W. Antifungal therapy during pregnancy. Clin Infect Dis 1998; 27:1151-60.
  • 18. Прилепская В.Н., Байрамова Г.Р. Применение натамицина в терапии смешанной вагинальной инфекции у женщин в I триместре беременности. Пробл Мед Микол 2003; 5(2):123-4.
  • 19. Буслаева Г.Н. Современные возможности терапии тяжелых микозов у детей раннего возраста. Фарматека 2005; 9:18-24.
  • 20. Engelhart C.M, Van der Vijver N.M., Nienhuis S.J., Hasaart T.H. Candida sepsis at midgestation: a case report. Eur J Obstet Gynecol Reprod Biol 1998; 77:107-9.
  • 21. Сергеев А.Ю., Сергеев Ю.В. Кандидоз: природа инфекции, механизмы агрессии и защиты, диагностика и лечение. М.: Триада-Х; 2000. – 472 с.
  • 22. Mendling W., Seebacher C. Guideline vulvovaginal candidosis: Guideline of German Dermatological Society, the German-Speaking Mycological Society and the Working Group for Infections and Infectimmunology of the German Society for Gynecology and Obstetrics. Mycoses 2003; 46:365-9.
  • 23. Arzeni D., Del Poeta M., Simonetti O., et al. Prevalence and antifungal susceptibility of vaginal yeasts in outpatients attending a gynecological center in Ancona, Italy. Eur J Epidemiol 1997; 13:447-50.
  • 24. Sobel J.D. Pathogenesis of recurrent vulvovaginal candidiasis. Curr Infect Dis Rep 2002; 4:514-9.
  • 25. Eschenbach D.A. Chronic vulvovaginal candidiasis. N Engl J Med 2004; 351:851-2.
  • 26. Bro F. Single-dose 500 mg clotrimazole vaginal tablets compared with placebo in the treatment of Candida vaginitis. J Farm Pract 1990; 31:148-52.
  • 27. Del Palacio A., Sanz F., Garcia-Bravo M., et al. Singledose treatment of vaginal candidosis: a randomised comparison of amorolfine (50 mg and 100 mg) and clotrimazole (500 mg) in patients with vulvovaginal candidosis. Mycoses 1991; 34:85-91.
  • 28. Gerhard I., Olhorst D., Eggert-Kruse W., et al. Topical one-day treatment with ketoconazole: a double blind randomized control study on vaginal candidosis. Mycoses 1989; 32:253-65.
  • 29. Stein G.E., Mummaw N. Placebo-controlled trial of itraconazole for treatment of acute vaginal candidiasis. Antimicrob Agents Chemother 1993; 37:89-92.
  • 30. Thomason J.L., Gelbart S.M., Kellet A.V., et al. Terconazole for the treatment of vulvovaginal candidiasis. J Reprod Med 1990; 35:992-4.
  • 31. Sobel J.D., Kauffman C.A., McKinsey D., et al. Candiduria: a randomized, double-blind study of treatment with fluconazole and placebo. Clin Infect Dis 2000; 30:19.
  • 32. Nixon S.A. Vulvovaginitis: the role of patient compliance in treatment success. Am J Obstet Gynecol 1991; 165:1207-9.
  • 33. Pereira R., Fidelis S., Vanunci M.L., et al. Bioequivalence study of two fluconazole capsule formulations in healthy volunteers. Int J Clin Pharmacol Ther 2004; 42:39-42.
  • 34. Васильева Н.В., Выборнова И.В., Елинов Н.П. Чувствительность Candida species к флуконазолу и некоторым его дженерикам в испытаниях in vitro. Пробл Мед Микол 2002; 2:43.
  • 35. Самсыгина Г.А. Эффективность различных препаратов флюконазола при лечении кожно-слизистого кандидоза у детей первых недель жизни. Детский Доктор 2001; 3:40-1.
  • 36. Зырянов С.К., Белоусов Ю.Б. Антибактериальная терапия: оригинальные препараты или дженерики. Ремедиум 2006; 5:12-4.
  • 37. Ткаченко Л.В., Жукова С.И. Преимущества комбинированной терапии хронического рецидивирующего кандидозного вульвовагинита. Гинекология 2005; 7(2):121-3.
  • 38. Байрамова Г.Р. Опыт терапии вульвовагинального кандидоза. Гинекология 2002; 4(2):84-5.
  • 39. Тихомиров А.Л., Олейник Ч.Г. Кандидозный вульвовагинит: взгляд на проблему. Гинекология 2005; 7(1):29-34.
  • 40. Кисина В.И. Комбинированная терапия урогенитальных инфекций в амбулаторной практике. Гинекология 2005; 7(1):26-9.
  • 41. Манухин И.Б., Захарова Т.П. Опыт клинического применения препарата «Румикоз» в лечении острого кандидозного вульвовагинита. Гинекология 2004; 6(1):19-22.
  • 42. Пекарев О.Г., Киселева Т.В. Новые возможности терапии кандидозного вульвовагинита препаратом «Ливарол». Гинекология 2004; 6(4):191-4.
  • 43. Шахова Н.М., Денисенко И.П. Оценка эффективности препарата «Ливарол» для лечения кандидозного вульвовагинита. Гинекология 2005; 7(1):34-7.
  • 44. Pappas P.G., Rex J.H., Sobel J.D., et al. Guidelines for treatment of candidiasis. Clin Infect Dis 2004; 38:161- 89.
  • 45. Gurwitz H.J., McLaughlin T.J., Fish L.S. The effect of an Rx-to-OTC switch on medication prescribing patterns and utilization of physician services: the case of vaginal antifungal products. Health Serv Res 1995; 30:672-85.
  • 46. Fong I.W. Clinical and cost considerations in the pharmacotherapy of vulvovaginal candidiasis. Pharmacoeconomics 1996; 9:497-505.
  • 47. Weinstein L., Henzl M.R., Tsina I.W. Vaginal retention of 2% butoconazole nitrate cream: Comparison of a standard and sustained release preparation. Clin Ther 1994; 16:930-4.
  • 48. Seidman L.S., Skokos C.K. An evaluation of butoconazole nitrate 2% site release vaginal cream (Gynazole-1) compared to fluconazole 150 mg tablets (Diflucan) in the time to relief of symptoms in patients with vulvovaginal candidiasis. Infect Dis Obstet Gynecol 2005; 13:197- 206.
  • 49. Del Palacio A., Sanz F., Sanchez-Alor G., et al. Doubleblind randomized dose-finding study in acute vulvovaginal candidosis. Comparison of flutrimazole site-release® cream (1, 2 and 4%) with placebo site-release® vaginal cream. Mycoses 2000; 43:355-65.
  • 50. Sood G., Nyirjesy P., Weitz M.V., Chatwani A. Terconazole cream for non-Candida albicans fungal vaginitis: results of a retrospective analysis. Infect Dis Obstet Gynecol 2000; 8:240-3.
  • 51. Mikamo H., Kawazoe K., Sato Y., et al. Comparative study on the effectiveness of antifungal agents in different regimens against vaginal candidiasis. Chemotherapy 1998; 44:364-8.
  • 52. Houang E.T., Chappatte O., Byrne D., et al. Fluconazole levels in plasma and vaginal secretions of patients after a 150-milligram single oral dose and rate of eradication of infection in vaginal candidiasis. Antimicrob Agents Chemother 1990; 34:909-10.
  • 53. Woolley P.D., Higgins S.P. Comparison of clotrimazole, fluconazole and itraconazole in vaginal candidiasis. Br J Clin Pract 1995; 49:65-6.
  • 54. Mårdh P.-A., Rodrigues A., Genc M., et al. Facts and myths on recurrent vulvovaginal candidosis – a review of epidemiology, pathogenesis, diagnosis and therapy. Int J STD AIDS 2002; 13:522-39.
  • 55. Sihvo S., Ahonen R., Mikander H., Hemminki E. Selfmedication with vaginal antifungal drugs: physicians’ expiriences and women’s utilization patterns. Fam Pract 2000; 17:145-9.
  • 56. Ferris D.G., Nyirjesy P., Sobel J.D., et al. Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis. Obstet Gynecol 2002; 99:419-25.
  • 57. McCaig L.F., McNeil M.M. Trends in prescribing for vulvovaginal candidiasis in the United States. Pharmacoepidemiol Drug Safe 2005; 14:113-20.
  • 58. Mårdh P.-A., Wagstrom J., Landgren M., Holmen J. Usage of antifungal drugs for therapy of genital Candida infections, purchased as over-the-counter products or by prescription: 2. Factors that may have influenced the marked changes in sales volumes during the 1990s. Infect Dis Obstet Gynecol 2004; 12:99-108.
  • 59. Czaika V., Tietz H.J., Schmalreck A., et al. Antifungal susceptibility testing in chronically recurrent vaginal candidosis as basis for effective therapy. Mycoses 2000; 43(Suppl.2):45-50.
  • 60. Nyirjesy P., Weitz M.V., Grody M.H.T., Lorber B. Overthe-counter and alternative medicines in the treatment of chronic vaginal symptoms. Obstet Gynecol 1997; 90:50- 3.
  • 61. Mathema B., Cross E., Dun E., et al. Prevalence of vaginal colonization by drug-resistant Candida species in college-age women with previous exposure to over-thecounter azole antifungals. Clin Infect Dis 2001; 33:23-7.
  • 62. Серов В.Н., Тютюнник В.Л. Вульвовагинальный кандидоз: особенности течения и принципы лечения. Фарматека 2005; 15:38-43.
  • 63. Spacek J., Buchta V. Itraconazole in the treatment of acute and recurrent vulvovaginal candidosis: comparison of a 1-day and 3-day regimen. Mycoses 2004; 48:165-71.
  • 64. Ringdahl E.N. Treatment of recurrent vulvovaginal candidiasis. Am Fam Physician 2000; 61:3306-12.
  • 65. Sobel J.D. Vulvovaginitis in healthy women. Comp Ther 1999; 25:335-46.
  • 66. Reed B.D., Gorenflo D.W., Gillespie B.W., et al. Sexual behavior and other risk factors for Candida vulvovaginitis. J Women’s Health Gend Based Med 2000; 9:645-55.
  • 67. Mårdh P.-A., Novikova N., Stukalova E. Colonization of extragenital sites by Candida in women with recurrent vulvovaginal candidosis. Br J Obstet Gynaecol 2003; 110:934-7.
  • 68. Fidel P.L. Jr. Vaginal candidiasis: review and role of local mucosal immunity. AIDS Patient Care Studies 1998; 12:359-66.
  • 69. Corrigan E.M., Clancy R.L., Dunkley M.L., et al. Cellular immunity in recurrent vulvovaginal candidiasis. Clin Exp Immunol 1998; 111:574-8.
  • 70. Carvalho L.P., Bacellar O., Neves N., et al.Downregulation of IFN-gama production in patients with recurrent vaginal candidiasis. J Allergy Clin Immunol 2002; 109:102-5.
  • 71. White D.J., Vanthuyne A., Wood P.M., Ayres J.G. Zafirlukast for severe recurrent vulvovaginal candidiasis: an open label pilot study. Sex Transm Infect 2004; 80:219-22.
  • 72. Bauters T.G., Dhont M.A., Temmerman M.I., Nelis H.J. Prevalence of vulvovaginal candidiasis and susceptibility to fluconazole in women. Am J Obstet Gynecol 2002; 187:569-74.
  • 73. Мирзабалаева А.К., Долго-Сабурова Ю.В., Савельева О.Г., Климко Н.Н. Возбудители хронического рецидивирующего кандидозного вульвовагинита и сочетанных форм генитальных инфекций у женщин. Вестн Росс Ассоц Акуш-гинекол 2001; 1:79-82.
  • 74. Nyirjesy P., Seeney S.M., Grody M.H., et al. Chronic fungal vaginitis: the value of cultures. Am J Obstet Gynecol 1995; 173:820-3.
  • 75. Sobel J.D., Wiesenfeld H.C., Martens M., et al. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med 2004; 351:876-83.
  • 76. Ribeiro M.A., Dietze R., Paula C.R., et al. Susceptibility profile of vaginal yeast isolates from Brazil. Mycopathologia 2000; 151:5-10.
  • 77. Richter S.S., Galask R.P., Messer S.A., et al. Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases. J Clin Microbiol 2005; 43:2155-62.
  • 78. Sobel J.D., Zervos M., Reed B.D., et al. Fluconasol susceptibility of vaginal isolates obtained from women with complicated Candida vaginitis: clinical implications. Antimicrob Agents Chemother 2003; 47:34-8.
  • 79. Lopez J., Pernot C., Aho S., et al. Decrease in Candida albicans strains with reduced susceptibility to fluconazole following changes in prescribing policies. J Hosp Infect 2001; 48:122-8.
  • 80. Кисина В.И., Степанова Ж.В., Мирзабекова М.А., Курчавов В.А. Зависимость клинической картины кандидозного вульвовагинита от видового состава грибов Candida и эффективность флуконазола при первичной и рецидивирующей кандидаинфекции. Гинекология 2000; 2(6):193-5.
  • 81. Kwok Y.K., Tay Y.K., Goh C.L., et al. Epidemiology and in vitro activity of antimycotics against Candida vaginal/ skin/nail infections in Singapore. Int J Dermatol 1998; 37:145-9.
  • 82. Nyirjesy P., Alexander A.B., Weitz M.V. Vaginal Candida parapsilosis: pathogen or bystander? Infect Dis Obstet Gynecol 2005; 13:37-41.
  • 83. Jackson S.T., Mullings A.M., Rainford L., Miller A. The epidemiology of mycotic vulvovaginitis and the use of antifungal agents in suspected mycotic vulvovaginitis and its implications for clinical practice. West Indian Med J 2005; 54:192-5.
  • 84. Candido R.C., Toloi M.R.T., Franceschini S.A., et al. In vitro activity of antimycotic agents determined by E-test method against vaginal Candida species. Mycopathologia 1999; 144:15-20.
  • 85. Carrillo-Muñoz A.J., Quindos G., Tur C., et al. In vitro antifungal activity of liposoml nystatin in comparison with nystatin, amphotericin B cholesteryl sulphate, liposomal amphotericin B, amphotericin B lipid complex, amphotericin B desoxycholate, fluconazole, and itraconazole. J Antimicrob Chemother 1999; 44:397-401.
  • 86. Carrillo-Muñoz A.J., Brio S., Quindos G., et al. Sertaconazole: in vitro antifungal activity against vaginal and other superficial yeast isolates. J Chemother 2001; 13:555-62.
  • 87. Carrillo-Muñoz A.J., Brio S., Alonso R., et al. Ciclopiroxolamine: in vitro antifungal activity against clinical yeast isolates. Int J Antimicrob Agents 2002; 20:375-9.
  • 88. Vasquez J.A., Sobel J.D. Mucosal candidiasis. Infect Dis Clin North Am 2002; 16:793-820.
  • 89. Sobel J.D. Treatment of vaginal Candida infections. Expert Opin Pharmacother 2002; 3:1059-65.
  • 90. Guaschino S., De Seta F., Sartore A., et al. Efficacy of maintenance therapy with topical boric acid in comparison with oral itraconazole in the treatment of recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 2001; 184:598-602.
  • 91. Urünsak M., Ilkit M., Evrüke C., Urünsak I. Clinical and mycological efficacy of single-day oral treatment with itraconazole (400 mg) in acute vulvovaginal candidosis. Mycoses 2004; 47:422-7.
  • 92. Goswami D., Goswami R., Banerjee U., et al. Pattern of Candida species isolated from patients with diabetes mellitus and vulvovaginal candidiasis and their response to single dose oral fluconazole therapy. J Infect 2006; 52:111-7.
  • 93. Мирзабалаева А.К., Долго-Сабурова Ю.В. Кандидоз гениталий и бактериальный вагиноз в практике акушера-гинеколога. Пробл Мед Микол 2004; 3:18-24.
  • 94. Friese K., Neumann G., Siebert J. Topical antiseptics as an alternative in the treatment of acute vulvovaginal candidosis. Arch Gynecol Obstet 2003; 268:194-7.
  • 95. Sobel J.D., Chaim W., Nagappan V., Leaman D.Treatment of vaginitis caused by Candida glabrata: use of topical boric acid and flucytosine. Am J Obstet Gynecol 2003; 189:1297-300.
  • 96. Phillips A.J. Treatment of non-albicans Candida vaginitis with amphotericin B vaginal suppositories. Am J Obstet Gynecol 2005; 192:2009-12.
  • 97. White D.J., Habib A.R., Vanthuyne A., et al. Combined topical flucytosine and amphotericin B for refractory vaginal Candida glabrata infections. Sex Transm Infect 2001; 77:212-3.
  • 98. Spinillo A., Capuzzo E., Acciano S., et al. Effect of antibiotic use on the prevalence of symptomatic vulvovaginal candidiasis. Am J Obstet Gynecol 1999; 180:14-7.
  • 99. Sobel J.D. Does lactobacillus prevent post-antibiotic vulvovaginal candidiasis. Curr Infect Dis Rep 2005; 7:443-4.
  • 100. Pirotta M.V., Garland S.M. Her choice: dealing with lactobacilli, vaginitis, and antibiotics. Curr Infect Dis Rep 2005; 7:445-52.
  • 101. Young G.L., Jewell D. Topical treatment for vaginal candidiasis in pregnancy. The Cochrane Library 2000; Issue 4:CD000225.
  • 102. Mastroiacovo P. Prospective assessment of pregnancy outcomes after first-trimester exposure to fluconazole. Am J Obstet Gynecol 1996; 175:1645-50.
  • 103. Jick S.S. Pregnancy outcomes after maternal exposure to fluconazole. Pharmacother 1999; 19:221-2.
  • 104. Ernest J.M. Topical antifungal agents and pregnancy. Obstet Gynecol Clin North Am 1999; 19:587-607.
  • 105. Czeizel A.E., Toth M., Rockenbauer M. No teratogenic effect after clotrimazole therapy during pregnancy. Epidemiology 1999; 10:437-40.
  • 106. Czeizel A.E., Kazy Z., Vargha P. A population-based case-control teratological study of vaginal econazole treatment during pregnancy. Eur J Obstet Gynecol Reprod Biol 2003; 111:135-40.
  • 107. Xu J., Sobel J.D. Candida vulvovaginitis in pregnancy. Curr Infect Dis Rep 2004; 6:445-9.
Views
0 Abstract
0 PDF
0 Crossref citations
Shared