Treatment of chronic vulvovaginal candidiasis with posaconazole and ciclopiroxolamine
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Abstract
Therapy of chronic recurrent vulvovaginal can- didiasis (VVC) caused by Candida glabrata is still rare in comparison to C. albicans infection, but therapy remains more difficult. Combination therapy with topical antifungals may improve therapy outcome, but still standard agents as fluconazole or itraconazole often fail. Posaconazole is a new systemic triazole with a wide antifungal spectrum including rare Candida species. Up to now, no clinical trials with posa- conazole in chronic recurrent VVC have been undertaken. Here, first results of the application of a new therapy regimen consisting of oral posaconazole in combination with topical ciclopiroxolamine are presented. 15 patients with chronic recurrent VVC caused by C. glabrata have been treated. 14 of these patients experienced successful therapy, clinical and mycological cure 30 days after begin of therapy has been observed. Long-term results are promising, as in 4 patients clinical and mycologic cure persists for more than 1 year up to now.
- Mendling, W. (2006) Vaginose, vaginitis, zervizitis und salpingitis. 2nd Edition, Springer Medizin Verlag, Hei- delberg.
- Watson, C. and Calabretto, H. (2007) Comprehensive re- view of conventional and non-conventional methods of management of recurrent vulvovaginal candidiasis. Aust N Z J Obstet Gynaecol, 47(4), 262-272.
- Eschenbach, D.A. (2004) Chronic vulvovaginal candidiasis. New England Journal of Medicine, 351(9), 851-852.
- González, G.M., et al. (2007) Therapeutic efficacy of posaconazole against isolates of Candida albicans with different susceptibilities to fluconazole in a vaginal mo- del. Medical Mycology, 45 (3), 221-224.
- Mendling, W., et al. (2008) Vulvovaginalkandidose. Guideline of the German Society of Gynecology and Obstetrics, German Dermatologic Society, German-Spea- king Mycologic Society, Berlin.
- Czaika, V., et al. (2000) Antifungal susceptibility testing in chronically recurrent vaginal candidosis as basis for effective therapy. Mycoses, 43(Suppl 2), 45-50.
- Pfaller, M.A., et al. (2001) Vitro activities of posaconazole (Sch 56592) compared with those of itraconazole and Fluconazole against 3,685 clinical isolates of Candida spp. and Cryptococcus neoformans. Antimicrobial Agents and Chemotherapy, 45(10), 2862-2864.
- Tietz, H.J. and Sterry W. (2006) Antimykotika von A-Z., Thieme, 4.Auflage, Stuttgart.
- Smith, W.J., Drew, R.H. and Perfect, J.R. (2009) Posaconazole’s impact on prophylaxis and treatment of invasive fungal infections: an update. Expert Review of Anti- Infective Therapy, 7(2), 165-181.
- Herbrecht, R. (2004) Posaconazole: A potent, extended spectrum triazole antifungal for the treatment of serious fungal infections. International Journal of Clinical Pra- ctice, 58(6), 612-624.
- Schiller, D.S. and Fung, H.B. (2007) Posaconazole: An extended spectrum triazole antifungal agent. Clinical Th- erapeutics, 29(9), 1862-1886.
- Hof, H. (2008) Is there a serious risk of resistance development to azoles among fungi due to the widespread use and long-term application of azole antifungals in medicine? Drug Resistance Updates, 11(1-2), 25-31.