Fungal

Yeast Infection No More

Candida Albicans Food List

Get Instant Access

Candidiasis

Multiple double-blind, randomized studies have proven the efficacy of both oral and topical antifungals for the treatment of candidiasis. Administration route is largely dependant on patient preference. Topical antifungals include butocona-zole, clotrimazole, miconazole, nystatin, terconazole, and tioconazole. Table 1 summarizes topical treatments tested in RCTs. Cure rates are over 80%, with

Table 1 RCT-Supported Topical Medications Proven Beneficial for Uncomplicated Vulvovaginal Candidiasis

Placebo

Treatment

controlled?

Comment

Reference

Butoconazole 2% cream 5 g

Yes

Also compared to

(52)

for 3 days

clotrimazole and miconazole

Butoconazole 2% cream 5 g,

No

Compared to miconazole

(53)

1 time

Clotrimazole 1% cream 5 g

No

Compared to terconazole

(54)

for 7-14 days

Clotrimazole 100 mg vaginal

No

Compared to clotrimazole

(55-57)

tablet for 7 days

14 days and miconazole, also to oral fluconazole

Clotrimazole 100 mg vaginal

No

Compared to tiaconazole,

(58-60)

tablet, 2 tablets for 3 days

itraconazole, and oral fluconazole

Clotrimazole 500 mg tablet,

Yes

Also compared to oral

(60-65)

1 time

fluconazole

Miconazole 2% cream 5 g for

Yes

Also compared with

(66)

7 days

terconazole

Nystatin 100,000 unit table

Yes

Has also been compared to

(67)

for 14 days

intravaginal imidazoles

Tioconazole 6.5% ointment

No

Compared to terconazole

(68)

5 g, 1 time

Teraconazole 0.4% cream 5 g

No

Compared to clotrimazole

(69)

for 7 days

Teraconazole 0.8% cream 5 g

No

Compared to tioconazole

(68)

for 3 days

Teraconazole 80 mg

Yes

Also compared to

(66,70)

suppository for 3 days

miconazole, and oral fluconazole

Abbreviation: RCT, randomized clinical trial.

Abbreviation: RCT, randomized clinical trial.

symptomatic resolution in 48-72 hours and mycological cure within four to seven days (71). Oral azoles (fluconazole, itraconazole, ketoconazole) also achieve high cure rates; however, fluconazole is currently the only FDA-approved agent (72). Itraconazole has been found to be as effective. Both methods of administration are available in prescription and over-the-counter forms. Oral agents may be preferable because of convenience and avoidance of skin sensitization, which has been associated with topical antifungals. Side effects of fluconazole are mild and infrequent, but include gastrointestinal intolerance, headache, and rash (71). There is increased hepatotoxicity with concomitant use of fluconazole with other hepatotoxic drugs, most notably statins. Oral azoles should not be used during pregnancy. One RCT has shown boric acid to be as effective in treatment as nystatin; however, this agent can cause skin irritation, is toxic if ingested, and should not be first-line therapy (73).

Candidia vulvitis can be classified into complicated and uncomplicated forms (51). Uncomplicated infection, which affects 90% of patients, is caused typically by Candida albicans and responds to a short-course oral or topical anti-fungal. There are currently many effective single-dose oral regimens, such as one-time dose of fluconazole, 150 mg. The rare infection with azole-resistant C. albicans requires higher doses of fluconazole. Ketoconazole is effective in treating uncomplicated candidiasis; however, hepatitis is a rare but serious side effect and the risks outweigh the benefits of its use in treating candidiasis.

Complicated candidiasis, seen in approximately 10% of the cases, requires antimycotic therapy for 10-14 days (72). Microbial infections with Candida species other than C. albicans, particularly C. glabrata, are less susceptible to azoles and azole therapy is unreliable. C. glabrata and the other non-albicans infections frequently respond to topical boric acid, 600 mg/d for 14 days or to topical flucytosine.

Recurrent vulvitis, defined as four or more episodes per year, is usually due to azole-susceptible C. albicans (72). Clinicians should assess patients for possible risk factors, such as uncontrolled diabetes mellitus, immunosuppression, or chronic antibiotic therapy. Multiple studies have demonstrated the effectiveness of a six-month antifungal maintenance suppressive therapy after an initial two-week induction regimen, resulting in negative cultures. Typically, induction is achieved with an oral azole. Acceptable maintenance therapies include oral fluconazole (150-200 mg weekly), oral ketoconazole (100 mg daily), oral itraconazole (100 mg every other day), or daily therapy with any topical azole (47). Two small RCTs provide insufficient evidence about regular prophylaxis with intravaginal imidazoles (74,75).

Was this article helpful?

0 0
How To Cure Yeast Infection

How To Cure Yeast Infection

Now if this is what you want, you’ve made a great decision to get and read this book. “How To Cure Yeast Infection” is a practical book that will open your eyes to the facts about yeast infection and educate you on how you can calmly test (diagnose) and treat yeast infection at home.

Get My Free Ebook


Post a comment