Vaginal azoles versus oral fluconazole in treatment of recurrent vulvovaginal candidiasis

Background: Vulvovaginal candidiasis (VVC) is a fungal infection of the vagina and vulva. It is usually caused by Candida albicans, however, occasionally other candida species are responsible. The optimal treatment of VVC has not yet been defined. The present study was designed to compare the efficacy and safety of a single oral dose of fluconazole with clotrimazole vaginal cream as the treatment of choice for recurrent VVC. Materials and methods: We conducted a clinical trial study on 124 women with RVVC. Sampling of vaginal discharge was achieved for clinically suspected patients, then, observed with KOH for vaginal candidiasis. Sample culture was performed for cases in whom the result of direct examination was negative but there was high clinical suspicion of the disease. For laboratory examination, swab specimens were placed on sabourauds agar plus chloramphenicol and cyclohexamide with natural PH. For treatment, patients were randomized systematically in 2 equal groups, one receiving clotrimazole vaginal cream 5g/day for 7 days for acute episode and 5g twice a week for 6 months as a prophylaxis. The second group was prescribed single oral dose of fluconazole capsule 150 mg for acute episode followed by prophylactic regimen of 150 mg weekly for 6 months. Results: A total of 124 women with RVVC were enrolled and assigned in 2 groups of fluconazole and clotrimazole with the mean age of 32±5 years (a range, 18-50 years) and 32±2 years (a range, 19-49 years), respectively. Of 117 cases, the recurrence rate was 8.6% in fluconazole and 8.5% in clotrimazole group. Recurrence rate in follow up period (second 6 months) was 38.3% and 40%, respectively (NS). Conclusion: Response to treatment and reduction in recurrence rate of VVC were similar among fluconazole and longterm users of azole vaginal creams.