Modern antimycotics in the treatment of various forms of vulvovaginal candidiasis

Interest in the incidence of vulvovaginal candidiasis in recent years has increased significantly due to the steady growth trend, the frequent recurrence of the process, the difficulties of therapy. Vulvovaginal candidiasis is one of the leading genital infections vagina, it can be attributed to the diseases of modern civilization. Often a long and persistent throughout the process, unwarranted use of various drugs, the lack of desired effect of the therapy leads to patients of various psychosomatic disorders, which certainly has an adverse impact on the organism as a whole.

Mushrooms of the genus Candida are part of the normal microflora of the vagina. 10-20% of women are kandidonositelyami. Kandidonositelstva criteria: absence of complaints of patients and clinical manifestations of disease, identification of yeasts in low titre (less than 10 CFU / ml). However, under the influence of certain exogenous and endogenous factors kandidonositelstvo can move in a clinically-defined form and cause disease.

Mushrooms of the genus Candida can cause a variety of infectious diseases - from local lesions of the mucous membranes and skin to life-threatening disseminated infection processes with extensive lesions of internal organs and systems. In this regard, a fungal infection is at the intersection of different disciplines and of great importance in a variety of clinical diseases: obstetrical and gynecological, dermatological, infectious diseases, nephrology, surgery, and others.

Mushrooms of the genus Candida includes more than 170 species, among which C.albicans has the greatest value in causing the disease. Its natural habitat is in the human body - the mouth, intestines, reproductive organs. It is believed that C.albicans is the causative agent of candidiasis in 75-80% of cases.

However, over the past 10 years has been a clear trend of increasing prevalence of vulvovaginal candidiasis caused by C. "non-albicans╩ species. More common S.glabrata, C.tropicalis, C.parapsilosis, C.krusei and others that are associated with chronic forms of the disease and difficult treatment.

Risk factors vulvaginalnogo candidiasis include:

╥ Physiological - Pregnancy

╥ Mechanical - intrauterine devices (especially long-term wearing it), the first sexual intercourse, tight synthetic clothing;

╥ Endocrine - diabetes, thyroid disease, the absolute or relative giperestrogenemiya;

╥ Iatrogenic - antibiotics, corticosteroids, immunosuppressive medication, oral contraceptives;

╥ Immunodeficiency;

╥ Infections, sexually transmitted diseases.

Vulvovaginal candidiasis is characterized by the following clinical symptoms:

╥ A thick white cheesy discharge;

╥ Itching of the vulva and vagina;

╥ Hyperemia and edema of the mucosa of the vulva and vagina.

By the nature of the disease are the following clinical forms:

╥ Kandidonositelstvo;

╥ Acute vulvovaginal candidiasis;

╥ Chronic (recurrent vulvovaginal candidiasis.

═ Treatment of vulvovaginal candidiasis

Vulvovaginal candidiasis therapy should be comprehensive, phased, include not only etiotropic treatment, but also the elimination of predisposing factors, and treatment of opportunistic diseases.

General provisions in the treatment of vulvovaginal candidiasis:

╥ It is necessary to strive for as complete elimination of the pathogen;

╥ Dosage and duration of treatment depends on the clinical course and evaluate the effectiveness of the therapy.

Basic principles of treatment of vulvovaginal candidiasis:

╥ Treatment with antifungal drugs;

╥ Preventive therapy (to prevent recurrence of the disease).

Local therapy

The advantage of local products is that they are practically not absorbed, creating a high concentration of antimycotics on the mucous membrane, provide a rapid decrease in clinical symptoms. Therefore, their use is justified in pregnancy and lactation.

The disadvantage of local therapy is the uneven distribution of the drug on the surface of the mucous membrane, which creates conditions for the preservation of the reservoir of infection. In the appointment of topical antimycotics is not ensured elimination of systemic candida infection in the other tanks, which can lead to recurrence of infection. Many patients point to the inconvenience of use, which reduces the quality of life.

These failures of local resources determine the relevance of systemic therapy.

Systemic therapy

The advantage of systemic antimycotics is the high efficiency of treatment, the distribution in many organs and tissues, and thus - the impact on the agent in any location. One important advantage of systemic antimycotics is easy to use compared to local vaginal forms.

Taking into account the growth of Candida resistance to antimycotics, currently systemic candidiasis therapy should be administered, taking into account the sensitivity of the pathogen. For example, C.krusei genetically resistant to fluconazole, and C.glabrata is dose-dependent to fluconazole, and only if it is applied at a dose of 400-800 mg per day is possible elimination of the pathogen.

So, if you hold the culture diagnosis is not possible, treatment should be antimycotics widest possible range of actions - itraconazole (Mikotroksom). In addition to broad-spectrum, highly lipophilic Mikotroks therefore retained in tissues after administration of the drug for 3 days, ensuring elimitnatsiyu pathogen.

An extremely common mistake is to assign for the treatment of vulvovaginal candidiasis polyene antimycotics - nystatin, levorin, natamycin as a "systemic" drugs. Their bioavailability is less than 5%, so the outside of the gastrointestinal tract, these antimycotics ineffective.

Scheme of treatment of acute vulvovaginal candidiasis systemic antimycotics:

╥ Itraconazole (mikotroks) 200 mg 2 times daily for 1 day or 200 mg once daily for 3 days;

╥ Fluconazole (difloks) 150 mg orally once.

Systemic antimycotics for the treatment of chronic vulvovaginal candidiasis (main course):

╥ Itraconazole (mikotroks) 200 mg 1 time per day 3-7 days;

╥ Fluconazole (difloks) 150 mg 3 times at intervals of 72 hours

╥ Ketoconazole 200 mg 2 times a day, 5 days.

Prevention of relapse of chronic recurrent vulvovaginal candidiasis:

╥ Itraconazole (mikotroks) 200 mg once a day once in a day of menstruation of 4-6 months;

╥ Fluconazole (difloks) 100-150 1 mg once a week, 6 months, then on day 1 of menstruation 6 months;

╥ Ketoconazole 100 mg 1 time per week 6 months.

Struggle with recurrent vulvovaginal candidiasis also include the correction of predisposing factors, chronic infections and other diseases, diabetes, disorders of immunity.

We recommend the use of vitamin complexes containing biotin.

Keep in mind that art is a doctor, among other things, and the ability to explain the reasons for a woman of her disease and the basic principles of treatment. Necessary to reassure the patient, and in case of psychological or other problems associated with her illness, to organize consultations with relevant experts.

Medical news № 1, 2007.