Clinical Observation And Evaluation Of Itraconazole For Vulvovaginal Candidiasis

ObjectiveTo explore the composition of candida strains in patients with severe vulvovaginal candidiasis(SVVC),and to evaluate the safety and efficacy of different oral itraconazole in the treatment of SVVC and oral itraconazole combined with nystatin in the treatment of refractory VVC.Combined with the results of drug sensitivity,the factors affecting the therapeutic effect of VVC were explored.MethodsThe clinical effects of 587 patients with SVVC and 99 patients with refractory VVC treated in Shenzhen Hospital of Peking University from 2012 to 2021 were observed and evaluated.SVVC patients were randomly divided into fluconazole group,itraconazole group for three days,itraconazole group for five days and itraconazole group for seven days.Short-term(7～14d)and long-term(30～35d)follow-up of clinical symptoms and vaginal secretions were collected for fungal microscopy and culture,respectively.For cured cases with long-term follow-up,follow-up was continued for 6 months(after the end of the first medication),and clinical symptoms and mycological recurrence were monitored.The results of fungal culture were used to evaluate the curative effect of cure and non-cure.Continuous positive culture meant no cure,while negative culture meant cure.The fungus culture was negative within 30 days of follow-up,and the recurrence of symptoms and signs or positive microscopic fungal or vaginal secretions culture within 6 months of follow-up was considered as recurrence.The therapeutic effect of different courses of itraconazole on SVVC was analyzed.Forty-eight pathogenic strains of SVVC patients were randomly selected for antifungal drug sensitivity test,and the factors affecting the therapeutic effect of SVVC were explored combined with the drug sensitivity results and the curing effect of different strains.99 patients with refractory VVC were treated with itraconazole for 7 days combined with nystatin for 14 days to explore the effect of combined treatment on refractory VVC.ResultsThe vaginal secretions of SVVC patients showed positive fungal culture,including 486 strains of Candida albicans(82.8%),81 strains of Candida albicans(13.8%),and 20 strains of other non-candida albicans non-candida albicans(3.5%).Compared with fluconazole group,itraconazole three-day group and itraconazole five-day group had 74.8%,77.4%and 60.7%short-term cure rates and 69.2%,75.6%and 51.2%long-term cure rates in SVVC treatment.In Candida albicans induced SVVC,the five-day itraconazole group had a significantly higher cure rate than fluconazole group(79.6%vs 62.1%).The short-term and long-term cure rates of the seven-day itraconazole group for SVVC were 78.3%and 78.3%.In the drug susceptibility test of SVVC strain,the geometric mean of MIC of Candida albicans against fluconazole and itraconazole increased in the untreated group,while the geometric mean of MIC of fluconazole and itraconazole in the untreated group was lower than that in the cured group.The long-term and short-term cure rates of itraconazole combined with nystatin for refractory VVC were 77.8%and 69.7%.ConclusionCandida albicans were more sensitive to fluconazole and itraconazole than nonCandida albicans.The microbeads of some patients with treatment failure had lower geometric mean MIC for nystatin.Compared with fluconazole two-dose therapy,3-day itraconazole and 5-day itraconazole therapy had a higher cure rate for SVVC.Itraconazole group for 7 days combined with nystatin vaginal suppository has good efficacy in the treatment of refractory VVC,which can be used as one of the clinical options.