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BMJ (Clinical Research Ed.) Jun 2020
Topics: Antifungal Agents; Candida; Candidiasis, Vulvovaginal; Female; Humans; Microbiological Techniques; Nonprescription Drugs; Practice Guidelines as Topic; Recurrence; Young Adult
PubMed: 32513647
DOI: 10.1136/bmj.m1995 -
Drug Design, Development and Therapy 2023Vulvovaginal candidiasis (VVC) is experienced by an estimated 75% of women at least once in their lifetime and is recurrent, defined as three or more infections per year... (Review)
Review
Vulvovaginal candidiasis (VVC) is experienced by an estimated 75% of women at least once in their lifetime and is recurrent, defined as three or more infections per year (RVVC) in 5-9%. Candida albicans is the most common causative agent, but up to 19% of infections may be related to non-albicans species. Available treatment options for VVC have consisted of oral and topical azoles (except for topical nystatin, a polyene). Oral polyenes are not absorbed and therefore not effective for VVC. Fluconazole is the only oral medication FDA approved for VVC. None of these treatments are FDA approved for RVVC. Ibrexafungerp, a triterpenoid fungicidal agent, was FDA approved in 2021, becoming the first oral non-azole agent for VVC. Ibrexafungerp reaches concentrations up to 9-fold higher in vaginal tissues versus plasma. In Phase 2 clinical trials, ibrexafungerp had a clinical cure rate comparable to fluconazole at day 10, but significantly better at day 25. In Phase 3 clinical trials, ibrexafungerp had both a higher clinical and mycologic cure rate versus placebo at both days 10 and 25. In December 2022, Ibrexafungerp received FDA approval for once monthly dosing to decrease the incidence of RVVC. This approval was based on data from the CANDLE STUDY, which showed 65.4% resolution of symptoms and culture negative success through week 24, compared to 53.1% of placebo. Ibrexafungerp provides an alternative oral option for treatment of acute, severe VVC. It is the only FDA approved antifungal for RVVC. Currently, the population likely to benefit from this drug are those with azole allergy, non-albicans or azole resistant albicans species, or other azole contraindications such as drug interactions (like statins or tricyclics). Side effects are mostly gastrointestinal and mild in nature. Ibrexafungerp, like fluconazole, should be used with caution in women who are or may become pregnant.
Topics: Pregnancy; Female; Humans; Candidiasis, Vulvovaginal; Fluconazole; Antifungal Agents; Triterpenes; Candida albicans; Azoles; Polyenes
PubMed: 36785761
DOI: 10.2147/DDDT.S339349 -
Revista Iberoamericana de Micologia 2017Vulvovaginal candidiasis is an old disease that, even in a modern world, continues to have a high incidence. Despite the therapeutic advances, treatments are not always... (Review)
Review
Vulvovaginal candidiasis is an old disease that, even in a modern world, continues to have a high incidence. Despite the therapeutic advances, treatments are not always effective, and our understanding of the pathogenesis of this fungal infection is still incomplete. A discussion is presented in this article on the most significant developments related to the fungal virulence factors, the role of the immunological mechanisms involved in the vaginal protection, and the genetic alterations that confer susceptibility to the recurrent form of this mycosis. Current treatments, the use of new agents with antifungal activity, as well as the development of strategies, such as vaccination, are approached in the context of the complex scenario that governs the interactions between Candida and its host.
Topics: Antifungal Agents; Biofilms; Candida; Candidiasis, Vulvovaginal; Cell Adhesion; Disease Susceptibility; Drugs, Investigational; Estrogens; Female; Fungal Vaccines; Host-Pathogen Interactions; Humans; Immunity, Innate; Opportunistic Infections; Randomized Controlled Trials as Topic; Recurrence; Species Specificity; Vagina; Virulence
PubMed: 28431891
DOI: 10.1016/j.riam.2016.11.006 -
The Australian & New Zealand Journal of... Apr 2017Recurrent vulvovaginal candidiasis (VVC) is a difficult-to-manage condition that affects 5-8% of women of reproductive age. Current treatment regimes have high relapse... (Comparative Study)
Comparative Study Review
BACKGROUND
Recurrent vulvovaginal candidiasis (VVC) is a difficult-to-manage condition that affects 5-8% of women of reproductive age. Current treatment regimes have high relapse rates, resulting in poor quality of life for the women affected.
AIM
To compare the quality and content of current guidelines concerned with recurrent VVC and to develop a summary of recommendations to assist in the management of women with this condition.
METHODS
Relevant clinical guidelines were identified through a search of several databases (MEDLINE, SCOPUS and The Cochrane Library) and relevant websites. Five guidelines were identified. Each guideline was assessed for quality using the AGREE II instrument. Guideline recommendations were extracted, compared and contrasted.
RESULTS
The identified guidelines were of mixed quality. This is not related to the level of evidence supporting them but is because of poor stakeholder involvement, applicability and lack of clarity concerning editorial independence. Current international guidelines for recurrent VVC are consistent in terms of their definition of the condition, diagnostic techniques and utilising induction and maintenance therapy as the treatment of choice. However, the regimen suggested by most guidelines (fluconazole weekly for six months) is not particularly effective; only 42.9% of patients are disease free after 12 months. An alternative regimen put forward by one of the guidelines cites a 77% cure rate after 12 months. Most guidelines lacked specific recommendations for the induction part of induction and maintenance treatment.
CONCLUSION
The current most recommended treatment of recurrent VVC is sub-optimal. Studies performed on a larger scale are required to identify more effective treatments.
Topics: Antifungal Agents; Candidiasis, Vulvovaginal; Female; Humans; Maintenance Chemotherapy; Practice Guidelines as Topic; Recurrence; Remission Induction
PubMed: 28299777
DOI: 10.1111/ajo.12592 -
Clinical Evidence Jun 2002
Comparative Study Review
Topics: Antifungal Agents; Candidiasis, Vulvovaginal; Female; Humans; Male; Pregnancy; Pregnancy Complications, Infectious; Randomized Controlled Trials as Topic; Recurrence; Sexual Partners; Treatment Outcome
PubMed: 12230789
DOI: No ID Found -
Lancet (London, England) Jun 2007Despite therapeutic advances, vulvovaginal candidosis remains a common problem worldwide, affecting all strata of society. Understanding of anti-candida host defence... (Review)
Review
Despite therapeutic advances, vulvovaginal candidosis remains a common problem worldwide, affecting all strata of society. Understanding of anti-candida host defence mechanisms in the vagina has developed slowly and, despite a growing list of recognised risk factors, a fundamental grasp of pathogenic mechanisms continues to elude us. The absence of rapid, simple, and inexpensive diagnostic tests continues to result in both overdiagnosis and underdiagnosis of vulvovaginal candidosis. I review the epidemiology and pathogenesis of this infection, and also discuss management strategies.
Topics: Antifungal Agents; Candidiasis, Vulvovaginal; Female; Humans; Severity of Illness Index
PubMed: 17560449
DOI: 10.1016/S0140-6736(07)60917-9 -
Current Women's Health Reports Aug 2001Widespread use of over-the-counter antifungal medications has contributed to a large increase in the number of women who experience more than three episodes of candida... (Review)
Review
Widespread use of over-the-counter antifungal medications has contributed to a large increase in the number of women who experience more than three episodes of candida vulvovaginitis per year. These women are particularly prone to chronic vulvovaginal pain syndromes; as such, the value of aggressive therapy based on detailed diagnosis extends well beyond immediate symptom relief. Diagnosis is complicated by the fact that a larger proportion of cases of are due to non-albicans species, which are not readily identifiable at office evaluation, and points to the value of fungal culture in such cases. Although most Candida albicans are sensitive to azole antifungals, non-albicans species are more often resistant, necessitating alternative therapies. In many cases therapy aimed at suppression of recurrence must extend 6 months. Ongoing studies may identify host factors that facilitate recurrence, and thus provide the basis for individually targeted therapy.
Topics: Administration, Intravaginal; Administration, Oral; Antifungal Agents; Candidiasis, Vulvovaginal; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Incidence; Prognosis; Recurrence; Risk Factors; Severity of Illness Index; Treatment Outcome; United States
PubMed: 12112949
DOI: No ID Found -
American Journal of Obstetrics and... Feb 1998Although it is the second most common vaginal infection in North America, vulvovaginal candidiasis is a non-notifiable disease and has been excluded from the ranks of... (Review)
Review
Although it is the second most common vaginal infection in North America, vulvovaginal candidiasis is a non-notifiable disease and has been excluded from the ranks of sexually transmitted diseases. Not surprisingly, vulvovaginal candidiasis has received scant attention by public health authorities, funding agencies, and researchers. Epidemiologic data on risk factors and pathogenic mechanisms remain inadequately studied. Most important, standards of care, including diagnosis and therapy, remain undefined. A conference was held in April 1996 to define and summarize what is known and supported by scientific data in the areas of epidemiology, diagnosis, and treatment of vulvovaginal candidiasis; but, more important, the conference aimed at defining what is not known, poorly studied, and controversial. Guidelines for the treatment and diagnosis of the different forms of vulvovaginal candidiasis are suggested.
Topics: Antifungal Agents; Candidiasis, Vulvovaginal; Female; Humans; Recurrence
PubMed: 9500475
DOI: 10.1016/s0002-9378(98)80001-x -
Journal of Women's Health (2002) Feb 2024
Topics: Female; Humans; Candidiasis, Vulvovaginal; Recurrence
PubMed: 37792339
DOI: 10.1089/jwh.2023.0556 -
Ethiopian Journal of Health Sciences Sep 2023Vulvovaginal candidiasis is one of the most common vaginal infections worldwide. We conducted this systematic review and meta-analysis to determine the effect of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Vulvovaginal candidiasis is one of the most common vaginal infections worldwide. We conducted this systematic review and meta-analysis to determine the effect of probiotics in the treatment of vulvovaginal candidiasis.
METHODS
A comprehensive search of databases including PubMed, Scopus, Cochrane, Scientific Information Database (SID), IranMedex, and Google Scholar search engine was performed. The search was conducted from inception to 1 October 2022, to identify published English or Persian language randomized control trials (RCTs) of women with vulvovaginal candidiasis who received probiotics as medical treatment. The quality of the included studies was assessed using the Oxford Center for Evidence Based Medicine checklist All statistical analyses were performed using Comprehensive Meta-analysis (CMA) version 2.
RESULTS
Six RCTs were included in this review. The results showed that treatment with probiotic was not different from placebo regarding the rate of positive culture (OR: 1.12; 95% CI: 0.390 to 3.26, P=0.825); treatment with probiotic was more effective compared to placebo regarding the rate of recurrence. (OR: 0.14; P= 0.01; 95 % CI: 0.028-0.7).
CONCLUSION
Probiotics have a beneficial effect in the treatment of women with vulvovaginal candidiasis. Our results provide evidence for an alternative treatment modality for vaginal candidiasis using probiotics.
Topics: Candidiasis, Vulvovaginal; Probiotics; Humans; Female; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 38784519
DOI: 10.4314/ejhs.v33i5.18