Managing recurrent vulvovaginal candidiasis. Intermittent prevention with itraconazole.
OBJECTIVE
To evaluate the efficacy of one-day, intermittent, monthly prophylaxis with 400 mg itraconazole in the management of recurrent vulvovaginal candidiasis.


METHODS
In a randomized trial, 57 patients and 57 controls with recurrent vulvovaginal candidiasis were assigned either to receive one-day monthly itraconazole prophylaxis for six months or no treatment. Clinical and mycologic evaluations were carried out 3, 6 and 12 months after enrollment.


RESULTS
During the first six months of follow-up, the rate of symptomatic recurrences was 36.4% (20/55) among the treated women and 64.2% (34/53) in the controls. The mean time +/- SEM to symptomatic recurrence was 149 +/- 6 days among patients receiving prophylaxis and 120 +/- 6 days in the controls (P = .003 by log-rank test). These differences disappeared almost completely after the cessation of intermittent prophylaxis. In fact, the proportion of patients still asymptomatic after one year of follow-up was 38.9% (21/54) among treated women and 28.8% (15/53) in the controls (P = .83 by Fisher's exact test).


CONCLUSIONS
One-day monthly, intermittent itraconazole prophylaxis reduced the rate of recurrence in patients with recurrent vulvovaginal candidiasis, but the beneficial effect of itraconazole was lost within a few months after cessation of prophylaxis.
Spinillo
A
A
Department of Obstetrics and Gynecology, University of Pavia, IRCCS Policlinico S. Matteo, Italy.
Colonna
L
L
Piazzi
G
G
Baltaro
F
F
Monaco
A
A
Ferrari
A
A
D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002181:Candidiasis, Vulvovaginal / Q000188:drug therapy / Q000517:prevention & control*; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage / Q000627:therapeutic use*; D012008:Recurrence
D000935:Antifungal Agents; D017964:Itraconazole