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Minerva Ginecologica 2019 August;71(4):321-8

DOI: 10.23736/S0026-4784.19.04388-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Combined systemic (fluconazole) and topical (metronidazole + clotrimazole) therapy for a new approach to the treatment and prophylaxis of recurrent candidiasis

Carlo GENOVESE 1, Antonio CIANCI 2, Salvatore CORSELLO 3, Giuseppe ETTORE 4, Paolo MATTANA 5 , Gianna TEMPERA 1

1 Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy; 2 Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; 3 Nursing Home Villa Serena, Palermo, Italy; 4 Unit of Obstetrics and Gynecology, Hospital Garibaldi-Nesima, Catania, Italy; 5 Medical Affairs, Alfasigma, Bologna, Italy



Recurrent vulvovaginal candidiasis (RVVC) is an important pathological and infectious condition that can greatly impact a woman’s health and quality of life. Clinical and epidemiological studies show that different types of therapies are able to eliminate the signs and symptoms of mycotic vaginitis in the acute phase, but so far none of these has proved able to significantly reduce the risk of long-term recurrence. In this review, based on the available literature and original data from a preliminary in-vitro microbiological study on the compatibility between fluconazole, clotrimazole and metronidazole a new therapeutic approach to RVVC is discussed and presented. The treatment proposed is a combined scheme using both systemic antimicrobial drug therapy with oral fluconazole 200 mg and topical drug therapy using the association metronidazole 500 mg and clotrimazole 100 mg (vaginal ovules) with adjuvant oral probiotic therapy. In detail, at the time of diagnosis in the acute symptom phase, we propose the following treatment scheme: fluconazole 200 mg on day 1, 4, 11, 26, then 1 dose/month for 3 months at the end of the menstrual cycle; plus metronidazole/clotrimazole ovules 1/day for 6 days the first week, then 1 ovule/day for 3 days the week before the menstrual cycle for 3 months; plus probiotic 1 dose/day for 10 days for 3 months starting from the second month to the end of the menstrual cycle. This scheme aims to address the recurrent infection aggressively from the outset by attempting not only to treat acute symptoms, but also to prevent a new event by countering many of the potential risk factors of recurrence, such as the intestinal Candida reservoir, the mycotic biorhythm, the formation of biofilm, the phenotype switching and the presence of infections complicated by the presence of C. non albicans or G. Vaginalis, without interfering, but rather favoring the restoration of the vaginal lactobacillus species. Future clinical studies will be useful to confirm the proposed scheme.


KEY WORDS: Fluconazole; Metronidazole; Clotrimazole; Probiotics; Candidiasis

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