Vulvovaginal candidiasis treatment

Asymptomatic vaginal colonization of Candida albicans is not diagnostic of vulvovaginal candidiasis since 10% to 20% of women are asymptomatic carriers of Candida species. Asymptomatic vaginal colonization does not require treatment. 

Ketoconazole remains useful in the treatment of cutaneous and mucous membrane dermatophyte and yeast infections, but it has been replaced by the newer triazoles in the treatment of most serious Candida infections and disseminated mycoses. Ketoconazole is usually effective in the treatment of thrush, but fluconazole is superior to ketoconazole for refractory thrush. Widespread dermatophyte infections on skin surfaces can be treated easily with oral ketoconazole when the use of topical antifungal agents would be impractical. Treatment of vulvovaginal candidiasis with topical imidazoles is less expensive. 

The two azoles most commonly used topically are clotrimazole and miconazole several others are available (see Preparations Available). Both are available over-the-counter and are often used for vulvovaginal candidiasis. Oral clotrimazole troches are available for treatment of oral thrush and are a pleasant-tasting alternative to nystatin. In cream form, both agents are useful for dermatophytic infections, including tinea corporis, tinea pedis, and tinea cruris. Absorption is negligible, and adverse effects are rare. 

Brown, D., Henzl, M. R., and Kaufman, R. H. (1999), Butoconazole nitrate 2% for vulvovaginal candidiasis. New, single-dose vaginal cream formulation vs. seven-day treatment with miconazole nitrate. Gynazole 1 Study Group, /. Reprod. Med., 44, 933-938. 

CTolhniazole is availabie as a solution in polyethylene ilunl 400. a lotion, and a cream in a concentration of These arc ail indicated for the treatment of tinea pedi.s. tr.i cruris, tinea capitis, tinea versicolor, or cutaneous 3diiiiasis. A 1% vaginal cream and tablets of 100 mg d II0 mg arc available for vulvovaginal candidiasis, ilttimizulc is extremely stable, with a shelf life of mote iin 5 years,... 

The first stage in practicing EBM is to define the precise question to which an evidence-based answer is required. A carefully focused question will inform the search for relevant evidence, and should (hopefully) avoid excessive retrieval of irrelevant publications and other information sources. For example, a clinician who wishes to know whether it is best to use oral or topical antifungals for the treatment of vaginal candidiasis could articulate the question as What is the relative effectiveness of oral versus intra-vaginal antifungals for the treatment of uncomplicated vulvovaginal candidiasis ... 

Recurrent vulvovaginal candidiasis (RV VC) is defined as having more than four episodes of VVC within a 12-month period. Fewer than 5% of women develop RVVC, and its pathogenesis is poorly nn-derstood. A proper diagnosis should be obtained to mle ont other infections or nonmycotic contact dermatitis. Most of the therapies are empirical and not based on proper randomized, controlled trials. Treatments include induction therapy, which should be administered for a minimum of 14 days or until clinical remission and negative cultures have been obtained. Table 118-2 fists the medications used for induction therapy. Induction therapy should be followed by a... 

Kaplan B, Royburt M, Rabinerson D, Neri A. Once-daily fluocinonide-bifonazole combination for the treatment of vulvar itching and vulvovaginal candidiasis Preliminary study. Clin Exp Obstet Gynecol 1996 23 173— 176. 

For many years, fungal infections were classified as either superficial nuisance diseases, such as athlete s foot or vulvovaginal candidiasis, or as relatively rare infections confined primarily to endemic areas of the country. When invasive fungal infections were encountered, amphotericin B was the only consistently effective, systemi-cally active agent available for the treatment of systemic mycoses. 

Butoconazole, a synthetic imidazole derivative with antifungal properties (2% vaginal cream with applicators to be used intravaginally at bedtime for 3 days), is indicated in the treatment of vulvovaginal candidiasis (moniliasis). 

Butoconazole is a vaginal antifungal agent that increases cell membrane permeability in susceptible fungi. It is indicated for local treatment of vulvovaginal candidiasis (monihasis). 

Clotrimazole has been reported to cure dermatophyte infections in 60 to 100% of cases. The cure rates in cutaneous candidiasis are 80 to 100%. In vulvovaginal candidiasis, the cure rate is usually above 80% when the 7-day regimen is used. A 3-day regimen of 200 mg once a day appears to be similarly effective, as does single-dose treatment (500 mg). Recurrences are common after all regimens. The cure rate with oral troches for oral and pharyngeal candidiasis may be as high as 100% in the immunocompetent host. 

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. 

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