Transactions from the 71st Annual Meeting of the Pacific Coast Obstetrical and Gynecological Society| Volume 192, ISSUE 6, P2009-2012, June 2005

Treatment of non-albicans Candida vaginitis with amphotericin B vaginal suppositories


      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.

      Study design

      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.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kent H.L.
        Epidemiology of vaginitis.
        Am J Obstet Gynecol. 1991; 65: 1168-1176
        • Duerr A.
        • Sierra M.F.
        • Feldman J.
        • Clake L.M.
        • Ehrlich I.
        • Dehovitz J.
        Immune compromise and prevalence of Candida vulvovaginitis in human immunodeficiency virus-infected women.
        Obstet Gynecol. 1997; 90: 252-256
        • Spinillo A.
        • Capuzzo F.
        • Egbe T.O.
        • Baltaro F.
        • Nicola S.
        • Piazzi G.
        Torulopsis glabrata vaginitis.
        Obstet Gynecol. 1995; 85: 993-998
        • Nyirjesy P.
        • Seeney S.M.
        • Grody M.H.T.
        • Jordan C.A.
        • Buckley H.R.
        Chronic fungal vaginitis: the value of cultures.
        Am J Obstet Gynecol. 1995; 173: 820-823
        • Ribeiro M.A.
        • Kietze R.
        • Paula C.R.
        • Da Matte D.A.
        • Colombo A.L.
        Susceptibility profile of vaginal isolates from Brazil.
        Mycopathologia. 2001; 151: 5-10
        • Sobel J.D.
        • Kapernick P.S.
        • Zervos M.
        • Reed B.D.
        • Hooton T.
        • Soper D.
        • et al.
        Treatment of complicated Candida vaginitis: comparison of single and sequential doses of fluconazole.
        Am J Obstet Gynecol. 2001; 185: 363-369
        • Horowitz B.J.
        Topical flucytosine therapy for chronic recurrent Candida tropicalis infections.
        J Reprod Med. 1986; 31: 821-824
        • Sobel J.D.
        • Chaim W.
        • Napgappan V.
        • Leaman D.
        Treatment of vaginitis caused by Candida glabrata: use of topical boric acid and flucytosine.
        Am J Obstet Gynecol. 2003; 189: 1297-1300
      1. White DJ, Habib AR, Vanthuyne A, Langford S, Symonds M. Combined topical flucytosine and amphotericin B for refractory vaginal Candida glabrata infections. Sex Transm Infect 200;77:212-3.

        • Fidel Jr., P.L.
        • Vazquez J.S.
        • Sobel J.D.
        Candida glabrata: review of epidemiology, pathogenesis, and clinical disease with comparison to C. albicans.
        Clin Microbiol Rev. 1999; 12: 80-96
        • Sobel J.D.
        • Faro S.
        • Force R.W.
        • Foxman B.
        • Ledger W.J.
        • Nyirjesy P.R.
        • et al.
        Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic consideration.
        Am J Obstet Gynecol. 1998; 178: 203-211
        • Chaim W.
        Fungal vaginitis caused by non-albicans species.
        Am J Obstet Gynecol. 1997; 177: 485-486
        • Stough W.V.
        • Blank H.
        Vaginal candidiasis in South Florida.
        Obstet Gynecol. 1958; 12: 338-340
        • Csonka G.W.
        Comparison of amphotericin B and nystatin pessaries in Candida infection of the vagina.
        Br J Vener Dis. 1967; 43: 210-211
        • Corkill B.M.
        • McCarthy N.J.
        Comparative trial of fungilin (amphotericin B) and pimafucin (natamycin) perssaries in the treatment of vaginal candidiasis.
        Med J Aust. 1972; 2: 33-34
        • Mick R.
        • Muller-Tyl E.
        • Neufeld T.
        Comparison of the effectiveness of nystatin and amphotericin B in female-mycoses.
        Wein Med Wochenschr. 1975; 125: 131-135
        • Toth B.
        • Simon J.
        • Palos H.
        Analysis of results in the therapy of vaginal moniliasis using an amphotericin B (Fungilin) pessary.
        Zentralbl Gynakol. 1973; 95: 463-469
      2. A new treatment for monilial vaginitis.
        Practitioner. 1971; 207: 236-238
        • Valentova M.
        • Klobusicky M.
        Fungilin in the therapy of vaginal candidiasis.
        Bratisl Lek Listy. 1971; 56: 203-210
        • Oller L.Z.
        Prevention of post-metronidazole condidosis with amphotericin B perssaries.
        Br J Vener Dis. 1969; 45: 163-166
        • Panaitescu D.
        • Perju A.
        • Balota V.
        Squibb's amphotericin B in treatment of Candida albicans and Trichomonas infections.
        Arch Roum Pathol Exp Microbiol. 1971; 30: 79-86
        • VanGijsegem M.
        Treatment of gynecologic infections by combined tetracycline and amphotericin B.
        Brux Med. 1971; 51: 391-393
        • Brenciaglia M.I.
        • Ilari M.
        • Lorino G.
        • Luciano R.
        • Mancini C.
        • Spitali R.
        Relationships between mycoplasma and vaginitis: experimental clinical study of 400 cases of vaginal diseases treated with the combination of amphotericin B and tetracycline.
        Minerva Ginecol. 1980; 32: 223-227
        • Patrono D.
        • Antonini B.
        • Santoro A.
        • Ceccarini M.
        Importance of infections of the primary female genital tract in obstetrical and gynecological pathology: the combination of tetracycline and amphotericin B in a new preparation in topical vaginal therapy.
        Minerva Ginecol. 1981; 33: 31-48
        • Rubin A.
        • Whitcomb M.
        • Russell M.
        • Amod N.D.
        Tetracycline and amphotericin B vaginal cream for mixed vaginal infections.
        S Afr Med J. 1983; 63: 395-397

      Linked Article

      • Discussion
        American Journal of Obstetrics & GynecologyVol. 192Issue 6
        • Preview
          Dr 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.
        • Full-Text
        • PDF
      • Closing discussion by Dr Phillips
        American Journal of Obstetrics & GynecologyVol. 192Issue 6
        • Preview
          Dr 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.
        • Full-Text
        • PDF