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Oral Ketoconazole and Miconazole Vaginal Pessary Treatment for Vaginal Candidosis
Author(s) -
Sharma J. B.,
Buckshee K.,
Gulati N.
Publication year - 1991
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1991.tb02798.x
Subject(s) - miconazole , medicine , ketoconazole , pessary , regimen , candida albicans , surgery , dermatology , antifungal , biology , genetics
EDITORIAL COMMENT: Ketoconazole (Nizoral) is available in Australia but is normally not indicated as first line therapy for candidiasis, largely because of the risk of hepatic damage (occasionally fatal) and because it is relatively expensive. The approved indications are for systemic or deep mycoses where other forms of therapy have failed, or recalcitrant cases of superficial mycoses which fail to respond to local therapy. The duration of the topical treatment in this study was longer than commonly used in Australia; miconazole pessaries (100 mg) were administered for 14 days whereas the usual regimen is to use 100 mg pessaries once daily for 7 days, or 200 mg pessaries once daily for 3 days. Since colonization of the bowel by Candida is a well known factor in recurrent candidiasis it is not surprising that use of a systemic and local agent concurrently was more effective than either therapy alone. We consider that the result obtained with local treatment (78% cure, 12% recurrence) would generally be regarded as quite acceptable in clinical practice. This study shows that topical or systemic antifungal agents are quite effective at eradicating Candida albicans with an enhanced effect if both modes of administration are used concurrently. Paul Drink water, Director of Pharmacy, Mercy Hospital for Women Summary: This prospective study was carried out on 250 patients having clinical and mycological evidence of vaginal candidosis. One hundred patients received ketoconazole orally (400 mg/day for 5 days), another 100 patients received miconazole vaginal pessary treatment (one 100 mg tablet locally for 14 days), while the other 50 patients received combination therapy of oral ketoconazole and miconazole vaginal tablets. Although all 3 regimens were significantly effective in relieving patients symptoms and physical signs, the combination therapy gave the best results. There was 98% symptomatic relief with the combination therapy in contrast to 82% and 78% in the oral ketocanozole and vagina] miconazole groups respectively (p < 0.001). Mycological cure rates were also significantly higher in the combination therapy group (94% versus 80% and 76%). The relapse rate was least in the combination group 2% versus 8% and 12%. The combination therapy is recommended for the best results in vaginal candidosis.