On day 7 to day 14 of follow-up, mycological cure of C. glabrata vulvovaginitis was achieved by 15 of 16 women (94%) treated with a nystatin vaginal suppository, compared with 8 of 19 (42%) given a miconazole nitrate vaginal suppository, 5 of 9 (56%) given oral fluconazole (Diflucan) and 7 of 15 (47%) given oral itraconazole (Sporanox). At day 30 to day 35 of follow-up, mycological cure rates, based on a positive or negative Candida culture, were 94%, 33%, 56%, and 40%, respectively.
“Nystatin vaginal suppository could be a therapy choice for vulvovaginal candidiasis caused by Candida glabrata,” Dr. Shangrong Fan said at the meeting.
While C. albicans is the most commonly isolated species, various studies have reported a shift towards infections caused by non-albicans Candida species such as C. glabrata.
The women were enrolled prospectively in separate, sequential, nonrandomized clinical trials and treated with nystatin vaginal suppository at 20 MU per day for 7 days or two 1,200-mg doses of miconazole vaginal suppositories 72 hours apart or oral fluconazole two 150-mg doses 72 hours apart or oral itraconazole 200 mg two times for 1 day.
Dr. Fan, an obstetrician/gynecologist and his colleagues at Peking University Shenzhen Hospital in Shenzhen, China, also conducted an in vitro susceptibility study. The in vitro susceptible rate of C. glabrata on nystatin was 100% (57/57), compared with 90% (51/57) for miconazole, 58% (40/69) for fluconazole, and 87% (58/67) for itraconazole. Resistance to nystatin or miconazole was not observed, and occurred in 3% of strains exposed to fluconazole and 1.5% exposed to itraconazole.
Dr. Fan and his associates reported no relevant financial disclosures.