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Review
Jack D Sobel
Division of Infectious Diseases, Wayne
State University School of Medicine,
Detroit, MI, USA
Introduction
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2014 Sobel. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution Non Commercial (unported,v3.0)
License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further
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http://dx.doi.org/10.2147/PPA.S38984
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Sobel
Formulation
Dose
Nystatin
Butoconazole
Clotrimazole
Miconazole
Terconazole
Tioconazole
Oral
Fluconazole
Itraconzole
Ketoconazole
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Oral
Three oral antimycotics have been used widely in the treatment of VVC, ie, fluconazole, itraconazole, and ketoconazole.
It is remarkable that no new antimycotics, including oral
agents, have been developed in the last two decades. In
addition, hepatotoxicity has resulted in withdrawal of ketoconazole from many formularies worldwide. This is perhaps
regrettable, given that the efficacy of ketoconazole is not
questioned and it may serve as the only effective oral agent
for some azole-resistant Candida species.
Accordingly, fluconazole remains the dominant oral triazole used worldwide and is now generic in most countries,
resulting in increased affordability. Generic antimycotics are
generally of equivalent potency and quality. An important
fact to be emphasized in this review is that oral and topical
antifungal agents are equally effective in treating VVC.6,1113
Oral fluconazole as a single agent is remarkably efficacious for VVC of mild or moderate severity, but additional
doses may be required for more severe VVC; this agent
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Oral
Comment
Pregnant
Speed of action
Efficacy
Recommended
Slightly quicker
Excellent
Not recommended
Slight delay
Excellent
OTC availability
Widely available
No
Convenience
Infrequent
Depends upon country and insurance
Unknown
Speculated possible
Unknown
With long-term use
Inconvenient
Convenient
Inconclusive data
Inconclusive data
Convenience and proven efficacy
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Sobel
Conclusion
Given the therapeutic efficacy and equivalence of the individual antifungal agents as well as route of administration,
treatment selection should be driven by the patients personal
preference. Clinicians should defer to the patients wishes
after discussing the very minor advantages and disadvantages of each route of antifungal drug administration based
upon individual patient characteristics. Often cultural and
insurance/cost-based considerations ultimately determine
drug selection and route of administration.
Disclosure
The author reports no conflict of interest in this work.
References
1. Ferris DG,Nyirjesy P,Sobel JD, Soper D, Pavletic A, Litaker MS. Overthe-counter antifungal drug misuse associated with patient-diagnosed
vulvovaginal candidiasis. Obstet Gynecol. 2002;99:419425.
2. Sobel JD, Subramanian C, Foxman B, Fairfax M, Gygax SE. Mixed
vaginitis more than coinfection and with therapeutic implications.
Curr Infect Dis Rep. 2013;15:104108.
3. Mendling W, Brasch J. German Society for Gynecology and Obstetrics,
Guideline vulvovaginal candidosis (2010) of the German Society for
Gynecology and Obstetrics, the Working Group for Infections and
Infect immunology in Gynecology and Obstetrics, the German Society
of Dermatology, the Board of German Dermatologists and the German
Speaking Mycological Society. Mycoses. 2012;55 Suppl 3:113.
4. [No authors listed]. National guideline for the management of
vulvovaginal candidiasis. Clinical Effectiveness Group (Association
of Genitourinary Medicine and the Medical Society for the Study of
Venereal Diseases). Sex Transm Infect. 1999;75 Suppl 1:S19S20.
5. Pappas PG, Kauffman CA, Andes D, etal. Clinical practice guidelines for
the management of candidiasis: 2009 update by the Infectious Diseases
Society of America. Clin Infect Dis. 2009;48:503535.
6. Reef SE, Levine WC, McNeil MM, et al. Treatment options for
vulvovaginal candidiasis, 1993. Clin Infect Dis. 1995;20 Suppl 1:
S80S90.
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