Fluconazole may curb recurrent candidiasis

OB/GYN News, Nov 15, 2002 by Sherry Boschert

SAN DEGO -- Recurrent vulvovaginal candidiasis was suppressed for 6 months in 91% of women given weekly fluconazole as a maintenance therapy, compared with 36% of those given placebo in a randomized, double-blind study of 387 women.

The results are good news for the more than 3 million U.S. women each year who suffer from recurrent vulvovaginal candidiasis, for which there is no other safe, proven maintenance therapy Topical prophylactic antifungal therapy is effective but inconvenient. Oral ketoconazole is effective but unsafe for maintenance therapy The new data show weekly oral fluconazole to be safe, convenient, and "highly effective" in controlling vulvovaginal candidiasis, Dr. Jack D. Sobel said at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy

Pfizer Inc., which markets fluconazole as Diflucan, helped fund the study.

Study participants were drawn from a larger cohort of women who presented with an acute episode of vulvovaginal candidiasis and had experienced at least four episodes in the prior year. Those who responded to initial unblinded treatment with three doses of fluconazole to induce remission were randomized to 6 months of maintenance therapy with 150-mg fluconazole once a week or placebo.

The women were followed for an additional 6 months after stopping maintenance therapy said Dr. Sobel, professor of medicine at Wayne State University, Detroit.

Following cessation of maintenance therapy relapse was more common in the fluconazole group than in the placebo group, affecting 59 of 193 women given fluconazole and 16 of 194 women on placebo. Patients with recurrences were retreated.

Because fluconazole was more effective during the 6 months of maintenance therapy, the overall cure rate was higher at the end of the full 12 months of the study in the fluconazole group than in the placebo group (43% vs. 22%), he reported at the meeting, sponsored by the American Society for Microbiology Most cases of candidiasis were due to Candida albi cans (94%) or Candida glabrata (3%). Maintenance therapy eradicated the organisms after 6 months in 79% of patients in the fluconazole group and 28% in the placebo group. No emergence of C. glabrata superinfection or selection was seen.