Clotrimazole and econazole in the treatment of vaginal candidosis. A single-blind comparison

Clotrimazole and econazole used as treatment for vaginal candidosis are both effective when given for three days. In a single-blind controlled study of 110 women followed for 14 days the efficacy of treatment with clotrimazole and econazole for three days was equal. Eighty-six per cent of the group treated with clotrimazole were mycologically clear at 14 days compared with 90% of those treated with econazole. Both treatment regimens were equally acceptable to the patients and no side effects were reported.     

Comparison of econazole and isoconazole as single dose treatment for vaginal candidosis.

In a single blind trial there was no significant difference between econazole (2 X 150 mg pessaries) and isoconazole (2 X 300 mg pessaries) given as a once only treatment for vaginal candidosis. Cure rates at 14 days were 70.4% for econazole and 77.6% for isoconazole, and at 28 days were 63.8% and 64.5% respectively. Though isoconazole was formulated for single dose usage, econazole was formulated for a regimen of one pessary a night for three nights.     

Treatment of vaginal candidosis with econazole nitrate and nystatin: A comparative study

A study carried out to compare the efficacy of econazole nitrate and nystatin in the treatment of vaginal candidosis showed that a three-day course of econazole nitrate pessaries was as effective as a 14-day course of nystatin pessaries and is more acceptable to patients.     

Single dose treatment of vaginal candidosis: comparison of clotrimazole and isoconazole.

The therapeutic efficacy of a single dose 500 mg tablet of clotrimazole was compared with two 300 mg tablets of isoconazole in an open randomised study of 100 patients with vaginal candidosis confirmed by mycological culture. One week after treatment 100% of the clotrimazole treated patients and 98% of the isoconazole treated group gave mycologically negative results. Five weeks after treatment these figures were 74% and 78% respectively, showing that both regimens were equally effective.     

Single dose treatment of vaginal candidosis: comparison of clotrimazole and isoconazole

The therapeutic efficacy of a single dose 500 mg tablet of clotrimazole was compared with two 300 mg tablets of isoconazole in an open randomised study of 100 patients with vaginal candidosis confirmed by mycological culture. One week after treatment 100% of the clotrimazole treated patients and 98% of the isoconazole treated group gave mycologically negative results. Five weeks after treatment these figures were 74% and 78% respectively, showing that both regimens were equally effective.     

Comparison of miconazole-coated tampons with clotrimazole vaginal tablets in the treatment of vaginal candidosis.

The effectiveness and acceptability of miconazole-coated tampons were compared with those clotrimazole vaginal tablets in the treatment of vaginal candidosis in 100 women. Both treatments were highly effective in reducing the signs and symptoms of infection; 95% of the group treated with miconazole had negative culture results for Candida species immediately after treatment compared with 86% of those treated with clotrimazole. A 17.6% recurrence rate of positive culture results was found four weeks later in the miconazole-treated group compared with that of 30% in the clotrimazole-treated group. The miconazole tampons were highly acceptable to patients. Vaginal pH values did not differ significantly between those patients with candidosis and those treated and cured. Corynebacterium vaginale (Gardnerella vaginalis) vaginitis and nonspecific genital infection were common complicating factors during follow up.     

Effect of simultaneous oral and vaginal treatment on the rate of cure and relapse in vaginal candidosis.

One hundred patients with vulvovaginal candidosis were entered in a double-blind trial to compare the effect of six days' local treatment with clotrimazole with that of the same treatment plus 10 days' oral treatment with nystatin. No significant differences were detected in the rate of cure or relapse between the treatment groups. The cure rate was lowest and the relapse rate highest in patients in whom vaginal candidosis had last been diagnosed during the preceding 12 months.     

Effect of simultaneous oral and vaginal treatment on the rate of cure and relapse in vaginal candidosis.

One hundred patients with vulvovaginal candidosis were entered in a double-blind trial to compare the effect of six days' local treatment with clotrimazole with that of the same treatment plus 10 days' oral treatment with nystatin. No significant differences were detected in the rate of cure or relapse between the treatment groups. The cure rate was lowest and the relapse rate highest in patients in whom vaginal candidosis had last been diagnosed during the preceding 12 months.     

Persistence of miconazole in vaginal secretions after single applications. Implications for the treatment of vaginal candidosis.

In vaginal secretions from 16 healthy women aged between 20 and 27 years miconazole persisted in biodetectable concentrations for at least 48 hours after insertion of a single miconazole vaginal pessary. This finding casts doubt on cure rates in vaginal candidosis determined soon after the end of treatment and suggests that current treatment courses with imidazole antifungal agents may be longer than their nominal three or five days.     

Recurrent vaginal candidosis: prospective study of effectiveness of maintenance miconazole treatment.

In a prospective study, 100 women with recurrent vaginal candidosis were treated with miconazole, using two 100 mg vaginal pessaries a day for one week, then one pessary twice a week for three months followed by one pessary a week for a further three months. Fifty four women elected to continue using one pessary a week for longer than six months. Symptomatic vaginal candidosis did not occur in any patient during regular maintenance treatment. Of the 46 women who discontinued treatment before six months, however, 22 had a recurrence. Maintenance prophylactic treatment with miconazole pessaries appears to be an acceptable and effective method of preventing recurrent episodes of vaginal candidosis.     

Intermittent local prophylaxis against recurrent vaginal candidosis.

Women with recurrent vaginal candidosis were treated until the infection cleared and were then given one clotrimazole 500 mg vaginal tablet a month or an identical placebo as prophylaxis. Of 21 women who received placebo, 16 developed symptoms or signs within three months, compared with nine of 17 women given active treatment. Women who relapsed were treated and then given active prophylaxis once a month. Of 30 women given such treatment, 13 relapsed within three months. Women who relapsed were treated and then given two clotrimazole 500 mg vaginal tablets a month. Of 17 women given prophylaxis twice a month, four developed symptoms or signs within three months, but 10 remained clear for 12 months. No appreciable difference was seen in the incidence of mycological recurrence between the different regimens; within three months over half the women in all treatment groups had become recolonised.     

Evaluation of a culture slide in the diagnosis of vaginal candidosis.

The Till-U-Test Candida Dermatophyte (TUT CD) culture slide, produced for the diagnosis of yeast and dermatophyte infections, was compared with microscopy and formal laboratory culture in the diagnosis of vaginal candidosis. Candida albicans grew readily on the medium and reliable results were obtained within a mean of three days' incubation at room temperature. Agreement with laboratory culture was 91 . 4%; 29% of cases would have been missed by microscopy alone. The TUT CD is a useful device, therefore, in the investigation of vaginitis.     

Single blind comparison of ketoconazole 200 mg oral tablets and clotrimazole 100 mg vaginal tablets and 1% cream in treating acute vaginal candidosis.

A single blind study of 103 women with vaginal candidosis was undertaken to compare treatment with conventional topical clotrimazole and oral ketoconazole. Both treatment regimens were equally effective in terms of clinical symptoms, negative results on culture for Candida albicans, and relapse rates. As treatment for vaginal candidosis takes several days, patient compliance is important and the success of a treatment regimen may depend on its acceptability to patients. Those in this study who had previously been treated for vaginal candidosis were asked to compare their current and previous treatments. Significantly more (p less than 0.001) of those treated with ketoconazole than those treated with clotrimazole found it more acceptable than previous treatment. This indicated a strong preference for oral treatment, and oral antifungal agents may be the treatment of choice for vaginal candidosis in the future.     

Comparison of vaginal flora after treatment with a clotrimazole 500 mg vaginal pessary or a fluconazole 150 mg capsule for vaginal candidosis.

The effect of antifungal therapy on the vaginal microbial flora was studied in 23 patients suffering from culture-positive, symptomatic vaginal candidosis. They were randomly allocated to receive either a 500 mg clotrimazole vaginal pessary or a 150 mg fluconazole capsule. Quantitative microbiological examination was carried out on samples of vaginal secretions obtained prior, and at intervals up to 10 days after, treatment. No significant difference was found in the vaginal flora before or after therapy in individual patients or between the treatment groups. In patients with C glabrata or C krusei, the yeasts persisted longer in the vagina with poorer response to either of the medications.     

Treatment of vaginal candidosis with a single 500-mg clotrimazole pessary.

In a double-blind study the therapeutic efficacy of a single 500-mg clotrimazole pessary was compared with that of a 200-mg clotrimazole pessary inserted once daily for three days in 72 patients with vaginal candidosis confirmed by culture. On clinical assessment four weeks after completion of treatment with the single-dose pessary the cure rate was 86% compared with 92% after the three-day regimen. There was no significant difference in the eradication rate between the single-dose (94%) and three-day regimens (89%). Four weeks after completion of treatment the recurrence rates by culture were 18% with the single-dose and 24% with the three-day regimen. The former treatment was well tolerated and as effective as the three-day clotrimazole regimen.