Anti-recurrent therapy of chronic VVC: realities and perspectives
Keywords:vulvovaginal candidiasis, therapy, reсurrence, fenticonazole, Lomexin
Chronic recurrent vulvovaginal candidiasis (VVC) occurs in 50% of women of childbearing age, while 20–50% of women in the normal microflora of the vagina determine fungi of the genus Candida without manifestation of clinical symptoms. To date, the search for schemes of VVC anti-recurrent therapy was carried out mainly in the aspect of the use of oral anti-mycotics.
However, taking into account their potential toxicity and drug load on patients at the groups of risk, the authors of the article note that it is most expedient to use local preparations.
The article presents the results of local therapy of chronic recurrent VVC by fenticonazole nitrate (drug Lomexin®) according to the proposed optimized scheme. The study involved 60 patients 18–45 years old, who were divided into 2 equal groups of 30 women. Patients of both groups were prescribed a basic treatment regimen: capsules of Lomexin® at a dose of 1000 mg for the 1st and 4th days on night intravaginally. In the course of further observation, the women of the main group received 600 mg of the drug once before the menstruation for 3 consecutive cycles. Women of the comparison group did not receive an anti-recurrent course. Assessment of symptoms of recurrent VVC was carried out after the end of menstrual cycle of the 5th month of observation in both groups.
The experience of local therapy of chronic VVC with a double dose of fenticonazole showed both high efficacy of the drug for topical use and compliance of this scheme. In particular, at the end of the basic therapy, the itching in the genital area ceased to disturb 95% of the patients. Excretas, which before treatment was noted by all patients, were concerned only 5% of those surveyed after therapy. Conduction of anti-recurrent therapy with capsules of Lomexin® 600 mg during 3 cycles once allowed to reduce the number of recurrence of VVC episodes to 2 (6.9%) of clinically pronounced cases, with symptomatology having a mild character.
The proposed scheme of anti-relapse therapy makes it possible to significantly reduce the frequency of recurrent episodes of the disease, which indicates its higher (93.1%) effect compared with the observation group (71.43%). The effectiveness of this scheme is extremely important for the local therapy of chronic VVC when choosing a drug for the treatment of patients with extragenital pathology, especially if there are contraindications to systemic therapy.
- Volosach, O.V. “Treatment of candidiasis: Opportunities and Prospects (The literature review).” Journal of Grodno State University 2 (2014): 19–23.
- Zaporozhan, V.N., Tatarchuk, T.F., Dubinina, V.G., Kosei, N.V. “Current diagnosis and treatment of endometrial hyperplastic processes.” Reproductive Endocrinology 1.3 (2012): 5–12.
- Infections in obstetrics and gynecology / Ed. by O.V. Makarov, V.A. Aleshkin, T.N. Savchenko. Moscow. MEDpress-inform (2007): 177–189.
- Kalugina, L.V., Tatarchuk, T.F. “Endometrial Polyps. Is the preventive treatment needed.” Reproductive Endocrinology 1 (2013): 69–75.
- Senchuk, A.Y., Doskoch, I.O., Martynova, D.A. “New opportunities in the treatment of vegetative forms of yeast CANDIDA in patients with mixed vulvovaginitis.” Women’s Health 8.74 (2012): 1–4.
- Soloviova, A.V., Plaksina, N.D., Silvestrova, G.A. “Vulvovaginal candidiasis: how to avoid relapses.” Womens’ doctor 2.52 (2014): 49–55.
- “A randomized multicenter study of the efficacy of 600 mg and 1200 Lomeksin drug in the treatment of vulvovaginal candidiasis in women of childbearing age.” Obstetrics and Gynecology 2 (2013).
- Tatarchuk, T.F., Kalugina, L.V., Shackalo, I.M. “Chronic vulvovaginal candidiasis: a new look at an old problem.” Reproductive Endocrinology 2.22 (2015): 69–75.
- Tatarchuk, T.F., Kosei, N.V. “Modern principles of treatment of pelvic inflammatory diseases.” Reproductive Endocrinology 1 (2013).
- Khamaganova, I.V. “Current approaches to the treatment of vulvovaginal candidiasis.” Reproductive Endocrinology 4 (2013): 60–64.
- Bacci, A. “Dendritic cells pulsed with fungal RNA induce protective immunity to Candida albicans in hematopoietic transplantation.” J Immunol 168.6 (2002): 2904–13.
- Fernаndez-Alba, J., Valle-Gay, A., Dibildox, M., et al.; The Fentimex Mexican Study Group. “Fenticonazole nitrate for treatment of vulvovaginitis: efficacy, safety, and tolerability of 1-gram ovules, administered as ultra-short 2-day regimen.” J Chemother 16 (2004): 179–86.
- Hauptmann, S., Kohler, G. “Etiology, Pathogenesis, and Malignant Potential of Uterine Leiomyoma – A Review.” Curr Obstet Gynecol Rep 3 (2014): 186–90.
- Ibrahim, A.S., et al. “Vaccination with recombinant N-terminal domain of Als1p improves survival during murine disseminated candidiasis by enhancing cell-mediated not humoral immunity.” Infect Immunol 73.2 (2005): 999–1005.
- Kovachev, S., Nacheva, A., Vacheva-Dobrevska, R., Vasilev, N. “Combined single-day treatment in acute vulvovaginal candidosis.” Akush Ginekol (Sofiia) 48.6 (2009): 18–23.
- Marchaim, D., Lemanek, L.; Bheemreddy, S., et al. “Fluconazole-Resistant Candida albicans Vulvovaginitis.” Obstet Gynecol 120.6 (2012): 1407–14.
- Muoz Reyes, J.R., Villanueva Reynoso, C., Ramos, C.J., et al. “Efficacy and tolerance of 200 mg fenticonazole versus 400 mg of miconazole in the intravaginal treatment of mycotic vulvovaginitis.” Ginecol Obstet Mex 70 (2002): 59–65.
- Bostwick, E.F. Pharmaceutical composition comprising Cryptosporidium parvum oocysts antigen and whole cell Candida species antigen: Patent US 5858378, A 61 K 39/39, A 61 K 39/002 1.12.1999. Galagen, Inc. Arden Hills. № 08/643032; 02.05.1996; 12.01.1999.
- Peters, B.M., Yano, J., Noverr, M.C., Fidel, P.L. Jr. “Candida Vaginitis: When Opportunism Knocks, the Host Responds.” PLoS Pathog 10.4 (2014): e1003965. DOI:10.1371/journal.ppat.1003965
- Sevilla, M.J., et al. “A fungicidal monoclonal antibody protects against murine invasive candidiasis.” Infect Immunol 74.5 (2006): 3042–5.
- Tatarchuk, T.F., Herman, D.G. “Endometrial polyps and micropolyps. Microbial landscape of the uterine сavity and its role in their formation.” Reproductive Endocrinology 6.32 (2016): 14–21.
- Gandhi, T.N., Patel, M.G., Jain, M.R. “Prospective study of vaginal discharge and prevalence of vulvovaginal candidiasis in a tertiary care hospital.” IJCRR 7.1 (2015): 34–38.
- Wang, Y.B., et al. “Analysis of ERG 11 gene mutation in Candid albicans.” Di Yi Jun Yi Da Xue Xue Bao 25.11 (2005): 1390–3.
- Zarnowski, R., Westler, W.M., Lacmbouh, G.A., et al. “Novel entries in a fungal biofilm matrix encyclopedia.” MBio 4.5 (2014): e01333–14.
- Ziegler, D., Borghese, B. “Endometriosis and infertility: pathophysiology and management. Review Article.” The Lancet 376.9742 (2010): 730–8.
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