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Published:November 16, 2016DOI:https://doi.org/10.1016/j.ajog.2016.11.1025
      In a recent review of recurrent vulvovaginal candidiasis, treatment options were described for women in whom no preventable triggering stimuli were forthcoming.
      • Sobel J.D.
      Recurrent vulvovaginal candidiasis.
      A suppressive maintenance prophylactic regimen with fluconazole was recommended and indeed this regimen is widely used and appreciated worldwide. In the review, attention was directed at 1 such regimen consisting of the use of once weekly fluconazole (150 mg) for a period of 6 months.
      • Sobel J.D.
      • Wiesenfeld H.C.
      • Martens M.
      • et al.
      Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis.
      Other alternative regimens were also immediately referenced including a more personalized but similar regimen of Dr Donders et al,
      • Donders G.
      • Bellen G.
      • Byttebier G.
      • et al.
      Individualized decreasing-dose maintenance fluconazole regimen for recurrent vulvovaginal candidiasis (ReCiDiF trial).
      the text emphasizing that these maintenance regimens have documented therapeutic efficacy and safety. No attempt was made to compare efficacy of the different maintenance fluconazole regimens since there are no data of comparative efficacy. In the accompanying letter Drs Ginc and Donders claim that their regimen of fluconazole called “ReCiDiF” is superior to the widely used once-weekly fluconazole regimen. Unfortunately, as mentioned above, no comparative study has ever been performed! Given the obvious differences in patient populations and treatment regimens utilized, attempts to compare study outcomes are not possible. To claim an advantage of the ReCiDiF regimen is without merit and is contrary to the respected scientific standard. A prospective randomized blinded study comparing the different fluconazole regimens would be welcomed.

      References

        • Sobel J.D.
        Recurrent vulvovaginal candidiasis.
        Am J Obstet Gynecol. 2016; 214: 15-21
        • Sobel J.D.
        • Wiesenfeld H.C.
        • Martens M.
        • et al.
        Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis.
        N Engl J Med. 2004; 351: 876-883
        • Donders G.
        • Bellen G.
        • Byttebier G.
        • et al.
        Individualized decreasing-dose maintenance fluconazole regimen for recurrent vulvovaginal candidiasis (ReCiDiF trial).
        Am J Obstet Gynecol. 2008; 199: 613.e1-613.e9

      Linked Article

      • Comment on treatment for recurrent vulvovaginal candidiasis
        American Journal of Obstetrics & GynecologyVol. 216Issue 4
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          With great interest we read the article “Recurrent vulvovaginal candidiasis” of Jack D. Sobel.1 The author presents oral and topical treatment strategies for recurrent vulvovaginal candidiasis. Therapy with oral fluconazole starts with an initial “induction therapy” and is followed by a maintenance phase, wherein the drug is given at certain intervals.2,3
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