Evidence‐based update on Australasian pharmaceutical prescribing approaches for recurrent vulvovaginal candidiasis

Strydom, Moira Bradfield; Walpola, Ramesh; Khan, Sohil; Ware, Robert S.; Tiralongo, Evelin

doi:10.1111/ajo.13376

Cited by 5 publications

(4 citation statements)

References 17 publications

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“…Negative cultures may be reflective of recent treatment, swab quality, and sampled location among other possible factors, for instance, misdiagnosis (the itching and burning of vulvodynia, Lichen sclerosus, and so on). Thus, the guidelines that focus only on a positive culture may not provide optimal care options for all patients, especially for those experiencing frequent recurrences (Bradfield Strydom et al, 2021). Adherence and persistence can be well accepted if RVVC is comprehensively explained.…”

Section: Discussionmentioning

confidence: 99%

Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion

Donders

Sziller

Paavonen

et al. 2022

Front. Cell. Infect. Microbiol.

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Recurrent vulvovaginal candidosis (RVVC) is a chronic, difficult to treat vaginal infection, caused by Candida species, which affects women of all ages and ethnic and social background. A long-term prophylactic maintenance regimen with antifungals is often necessary. In most clinical practice guidelines, oral fluconazole is recommended as the first-line treatment. Although clinical resistance to antifungal agents remains rare, overexposure to azoles may increase the development of fluconazole-resistant C. albicans strains. In addition, non-albicans Candida species are frequently dose-dependent susceptible or resistant to fluconazole and other azoles, and their prevalence is rising. Available therapeutic options to treat such fluconazole-resistant C. albicans and low susceptibility non-albicans strains are limited. Ten experts from different European countries discussed problematic issues of current RVVC diagnosis and treatment in two audiotaped online sessions and two electronic follow-up rounds. A total of 340 statements were transcribed, summarized, and compared with published evidence. The profile of patients with RVVC, their care pathways, current therapeutic needs, and potential value of novel drugs were addressed. Correct diagnosis, right treatment choice, and patient education to obtain adherence to therapy regimens are crucial for successful RVVC treatment. As therapeutic options are limited, innovative strategies are required. Well- tolerated and effective new drugs with an optimized mechanism of action are desirable and are discussed. Research into the impact of RVVC and treatments on health-related quality of life and sex life is also needed.

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Section: Discussionmentioning

confidence: 99%

Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion

Donders

Sziller

Paavonen

et al. 2022

Front. Cell. Infect. Microbiol.

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“…Some studies utilizing NGS identify even higher asymptomatic vaginal carriage among women ranging from 33-98 % [26][27][28]. Carriage and detection of Candida species are of interest in RVVC as it is common for patients to have negative cultures whilst symptomatic, which could be reflective of treatment recency, microbial load, swab quality [9] or associated with aspects of RVVC pathogenesis that requires further exploration.…”

Section: The Fungal Vaginal Microbiome In Rvvcmentioning

confidence: 99%

“…As such, one would expect that species-level data of fungal and bacterial inhabitants of the gastrointestinal tract and vagina from next-generation sequencing (NGS) to illuminate RVVC pathogenesis and inform new prescribing approaches for RVVC [9].…”

Section: Introductionmentioning

confidence: 99%

Interplay of the microbiome and antifungal therapy in recurrent vulvovaginal candidiasis (RVVC): A narrative review

Strydom

Khan

Walpola

et al. 2023

Journal of Medical Microbiology

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Recurrent vulvovaginal candidiasis (RVVC) is a microbial, immune and sexual health disorder impacting up to 10 % of the adult female population. Fluconazole is a well-established antifungal drug commonly utilized for acute and long-term RVVC treatment. This insight review provides an overview of known vaginal and gastrointestinal microbiota characteristics in RVVC, presents the potential impacts of fluconazole therapy on multi-microbiome relationships and discusses implications for future research and clinical practice. Next-generation sequencing (NGS) and molecular methods to accurately define vaginal microbiota trends in RVVC are not comprehensively available, limiting understanding of microbiota roles in RVVC. Inconsistencies and variances in Lactobacillus profiles in RVVC women suggest poorly understood disease implications on the bacterial and fungal microbiomes. Investigations of environmental conditions like vaginal pH, drug therapy’s impact, especially fluconazole maintenance therapy, and the elucidation of multi-microbiome relationships in RVVC are required to further investigate disease pathogenesis and responsible antimicrobial prescribing.

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“… 1 Azole therapy may be used as required or as extended daily or weekly maintenance therapy for 6 months or more. 2 , 3 These maintenance regimes often utilize fluconazole for its better safety profile. A Cochrane Review showed that 57% of people with RVVC experience relapse within 3–6 months of ceasing maintenance therapy.…”

Section: Introductionmentioning

confidence: 99%

Intravaginal Combination Therapy of Acetic and Lactic Acid in premenopausal women with recurrent vulvovaginal candidiasis: A randomized, double-blind placebo-controlled feasibility trial

Strydom,

Khan,

Walpola

et al. 2023

Womens Health (Lond Engl)

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Background: Recurrent vulvovaginal candidiasis management primarily entails azole therapy used as required or as an extended daily or weekly maintenance therapy for 6 months or more. Unfortunately, relapse within 3–6 months of ceasing maintenance therapy is experienced for more than half the patients, for whom indefinite treatment is required. Objectives: To explore the feasibility of trial design examining a prophylaxis treatment to prevent recurrent vulvovaginal candidiasis symptomatic episodes and reduce adverse effects. Study Design: A double-blinded randomized controlled feasibility trial was conducted in Australia. Women with recurrent vulvovaginal candidiasis were enrolled. Methods: An intravaginal prophylaxis application of lactic acid and acetic acid (Intravaginal Combination Therapy of Acetic and Lactic Acid) was compared with placebo. Primary outcomes comprised recruitment and retention, compliance to study medications and study assessments. Secondary outcomes included the reduction of symptomatic recurrence over the trial period and the acceptability, satisfaction, safety and tolerability of the intervention. The feasibility of quality-of-life measures was also explored. Results: Fifteen participants were enrolled and randomized (active = 9, placebo = 6). Consent rate was 23.4%. Eight participants were lost to follow-up (active = 5, placebo = 3). Forty-seven per cent of participants (n = 7) were 100% compliant with the intervention, six of which completed the trial with good assessment compliance. The blinding process was effective. The study demonstrated a reduction in relapse in both active and placebo groups with only four participants across both groups reporting symptomatic episodes while enrolled. The intervention demonstrated good tolerability. Quality-of-life data showed minimal variance with a high quality-of-life measure. Conclusion: This trial assesses the feasibility of conducting a large-scale study exploring the efficacy of the Intravaginal Combination Therapy of Acetic and Lactic Acid intravaginal intervention and hints on the importance of psychological support through appropriate disease-specific communication and clinical attention. Consideration of the reported recruitment challenges, the inclusion of suitable quality-of-life measures and digital data collection is warranted for adaptation to a fully powered trial.

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Evidence‐based update on Australasian pharmaceutical prescribing approaches for recurrent vulvovaginal candidiasis

Cited by 5 publications

References 17 publications

Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion

Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion

Interplay of the microbiome and antifungal therapy in recurrent vulvovaginal candidiasis (RVVC): A narrative review

Intravaginal Combination Therapy of Acetic and Lactic Acid in premenopausal women with recurrent vulvovaginal candidiasis: A randomized, double-blind placebo-controlled feasibility trial

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