This study was undertaken to investigate whether amphotericin B vaginal suppositories would be effective in the treatment of non-albicans Candida vaginitis in women who failed conventional therapy.
Thirty-two patients were identified with non-albicans Candida vaginitis. These patients were treated with conventional antifungal agents. Ten patients had persistence of the non-albicans Candida infection after treatment. Amphotericin B 50-mg vaginal suppositories were given nightly for 14 days to this subgroup of treatment failures.
Of 10 women, 8 (80%) who were treated with amphotericin B vaginally initially showed no further infection. One of the treatment successes had 2 recurrences and responded to a second course of amphotericin B but failed a third course. If this patient is considered a treatment failure, then amphotericin B vaginal suppositories were successful in 70% of patients. The medication was well tolerated and local side effects were minimal.
Amphotericin B vaginal suppositories are a viable treatment option for refractory vaginitis caused by non-albicans Candida.
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Presented at the 71st Annual Meeting of the Pacific Coast Obstetrical and Gynecological Society, October 19-24, 2004, Phoenix, Ariz.
© 2005 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
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- DiscussionAmerican Journal of Obstetrics & GynecologyVol. 192Issue 6
- PreviewDr Vera Stucky, San Marcos, Calif. Dr Phillips has provided us with a retrospective review of 10 years of office practice identifying 30 patients with non-albicans Candida vaginitis. Twenty patients were identified by potassium hydroxide wet mount and 10 by culture after they failed to respond to traditional topical azole treatment. The patients were then given either systemic fluconazole or ketoconazole, and if they continued to have symptoms, they were given compounded amphotericin B suppositories.
- Closing discussion by Dr PhillipsAmerican Journal of Obstetrics & GynecologyVol. 192Issue 6
- PreviewDr Phillips (Closing). In response to Dr Golditch's question, cure was defined as resolution of symptoms and a negative culture. Aside from the immediate follow-up visit between 7 and 14 days after treatment, I did not have the patients return specifically for additional follow-up visits. I would note that these patients were my private practice patients and I see the majority of them yearly and none of them had a recurrence, except 1 patient who had another infection with C glabrata at 9 months after initial treatment.