title: Topical antifungal agents.
abstract: Current knowledge of fungal cell architecture and biochemistry allows limited understanding of the mode of action of presently available topical antifungal agents. Nystatin, first introduced in the 1950s for treatment of vulvovaginal candidiasis, has been surpassed by the imidazoles and triazoles as the first choice of treatment for vulvovaginal candidiasis. The lack of clear superiority of any one azole agent or dosing regimen leads some authors to recommend a short course of therapy (1-3 days) for acute uncomplicated candidal vaginitis using factors including anatomic distribution of inflammation and patient preference (such as previous hypersensitivity or allergic reaction to the agent, the cost of the agent, and the preferred vehicle for administration of the agent) to choose the specific antifungal agent (see Table 1). Recurrent cases or treatment during pregnancy may require longer therapy (6-14 days), again using an agent chosen because of these factors. Although theoretic risks may exist, actual harm to the fetus or pregnancy has not been demonstrated with the use of the topical azoles during any trimester of pregnancy. The development of antimycotic resistance need not be considered in infrequent and occasional episodes of candidal vaginitis, and it is rarely a cause of treatment failure even in chronic or recurrent cases.
authors.affiliation: Department of Obstetrics and Gynecology, Wake Forest University Medical Center, Winston-Salem, North Carolina.
authors.forename: J M
authors.initials: JM
authors.lastname: Ernest
mesh_terms: D000287:Administration, Topical; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000737:chemistry / Q000627:therapeutic use; D002181:Candidiasis, Vulvovaginal / Q000188:drug therapy*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*
chemical_list: D000935:Antifungal Agents