Vaginal infections, treatment

Fluconazole (4) (s the first member of a new generation of orally acti ve antifungal agents, highly effective in the treatment of dermal and vaginal infections [6, 7] S-Fluorocyrtosine (5) is also used to treat serious systemic fungal infections [5]... 

Clotrimazole (Lotrimin, Gyne-Lotrimin, Mycelex) is a broad-spectrum fungistatic imidazole drug used in the topical treatment of oral, skin, and vaginal infections with C. albicans. It is also employed in the treatment of infections with cutaneous dermatophytes. 

Is a site-specific application required or is it preferable for the drug to be distributed rapidly throughout the vaginal space, as might be the case for an anti-infective treatment ... 

Pavelic, Z., Skalko-Basnet, N., and Jalsenjak, I. (1999), Liposomes containing drugs for treatment of vaginal infections, Eur. J. Pharm. Sci., 8, 345-351. 

If vaginal candidiasis has not been previously diagnosed by a doctor. There are other vaginal infections, some serious and all requiring treatment with prescription-only medication, with symptoms that could be confused with thrush. An initial medical diagnosis of candidiasis is necessary so that sufferers can recognise the condition subsequently. 

Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996 275 870-876. 

Prior to undergoing medical termination of pregnancy, women must be informed about this rare complication. If a vaginal infection is present, antibiotics are indicated. Ideally, all women should be screened for infection and treated before termination of pregnancy. However, in practice, this is rarely done. In Europe, routine prophylactic antibiotic treatment is not uncommon [53]. 

In the treatment of tinea pedis, tinea cruris, and tinea versicolor the cure rate may be over 90%. In the treatment of vulvovaginal candidiasis, the mycologic cure rate at the end of 1 month is about 80 to 95%. Pruritus sometimes is relieved after a single application. Some vaginal infections caused by Candida glabrata also respond. 

Thrombolytic agents a need for improvement Thyroid preparations Trace minerals essential for health Traveler s diarrhea prevention of Tuberculosis treatment of Upper respiratory tract infection treatment of Urinary tract infections treatment of Uveitis management of Vaginal candidiasis treatment of Vasodilators effects on cardiac output (CO)... 

Metronidazole was initially introduced for the treatment of vaginal infections caused by Trichomonas vaginalis but has since been shown to be effective for treatment of amebiasis, giardiasis, and anaerobic bacterial infections, including Clostridium difficile. 

Historical use, both in indigeneous practice and in medicine, shows it to be specific as a treatment for malaria as well as typhoid, diphtheria, and influenza, especially with attending fetid conditions such as upper respiratory infection with foul breath or fetid catarrh, infected wound with foul discharge, foul diarrhea, vaginal infection with foul discharge, and gangrenous conditions. 

Nystatin is mainly used to treat vaginal and oral infections and localized skin lesions, including Candida intertrigo and Candida nappy dermatitis. It may also be used as prophylaxis during treatment with antibiotics. 

Dyspareunia may result from vaginal dryness. Water-based lubricants may provide relief for several hours after application. Moisturizers may provide relief for a longer period of time and potentially can prevent infections by maintaining the acidic environment in the vagina. Both these treatments require frequent application. 

Response rates are lower for non-albicans infections. Although an optimal regimen is unknown, use of intravaginal azole therapy for 7 to 14 days is recommended. Terconazole may prove more effective than other azoles in the treatment of non-albicans infections since C. glabrata and C. tropicalis are more susceptible to terconazole.17 For second-line therapy, boric acid 600 mg in a gelatin capsule administered vaginally twice daily for 2 weeks followed by once daily during menstruation is effective.18 Local irritation often limits the use of boric acid. Topical 4% flucytosine is also effective but use should be limited due to the potential for resistance. 

Use primarily for treatment of patients with progressive and potentially fatal fungal infections. Do not use to treat noninvasive forms of fungal disease such as oral thrush, vaginal candidiasis, and esophageal candidiasis in patients with normal neutrophil counts. 

Nystatin (Mycostatin) is a polyene antifungal drug with a ring structure similar to that of amphotericin B and a mechanism of action identical to that of amphotericin B. Too toxic for systemic use, nystatin is limited to the topical treatment of superficial infections caused by C albicans. Infections commonly treated by this drug include oral candidiasis (thrush), mild esophageal candidiasis, and vaginitis. 

Fluconazole is very effective in the treatment of infections with most Candida spp. Thrush in the end-stage AIDS patient, often refractory to nystatin, clotrimazole, and ketoconazole, can usually be suppressed with oral fluconazole. AIDS patients with esophageal candidiasis also usually respond to fluconazole. A single 150-mg dose has been shown to be effective treatment for vaginal candidiasis. A 3-day course of oral fluconazole is effective treatment for Candida urinary tract infection and is more convenient than amphotericin B bladder irrigation. Preliminary findings suggest that Candida endophthalmitis can be successfully treated with fluconazole. Stable nonneutropenic patients with candidemia can be adequately treated with fluconazole, but unstable, immunosuppressed patients should initially receive... 

Despite negligible cerebrospinal fluid concentrations, itraconazole shows promise in the treatment of cryptococcal and coccidioidal meningitis. Additional uses for itraconazole include treatment of vaginal candidiasis, tinea versicolor, dermatophyte infections, and onychomycosis. Fungal naU infections account for most use of this drug in the outpatient setting. 

Miconazole (Monistat) is a broad-spectrum imidazole antifungal agent used in the topical treatment of cutaneous dermatophyte infections and mucous membrane Candida infections, such as vaginitis. Minimal absorption occurs from skin or mucous membrane surfaces. Local irritation to skin and mucous membranes can occur with topical use headaches, urticaria, and abdominal cramping have been reported with treatment for vagiiutis. 

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