Trends in prescribing for vulvovaginal candidiasis in the United States.
OBJECTIVE
To describe trends in visits to office-based physicians in the United States by females 15-64 years of age for vulvovaginal candidiasis and related antifungal prescribing. Since January 1991, intravaginal antifungal medications have been available over-the-counter in the United States to treat vulvovaginal candidiasis.


METHODS
Data from the 1985 through 2001 National Ambulatory Medical Care Surveys (NAMCS) were examined. NAMCS is an annual national probability sample survey that collects data on the utilization of services provided by office-based physicians.


RESULTS
The average annual visit rates for symptoms of vaginitis and a diagnosis of vulvovaginal candidiasis decreased by 55 and 72%, respectively. The intravaginal antifungal prescribing rate for vulvovaginal candidiasis declined by 41%. No trend was found for total antifungal prescribing; however, during the late 1990s, fluconazole was prescribed at approximately one-third of visits with a diagnosis of vulvovaginal candidiasis.


CONCLUSIONS
These data suggest an increased trend in self-diagnosis and use of over-the-counter intravaginal antifungal medications. The shift from prescribing intravaginal antifungal preparations to fluconazole raises concern about the possible development of azole drug resistance. Educational efforts are needed to counter potential misuse of these medications that may contribute to increased infection with innately azole resistant non-albicans Candida species and chronic infection.
McCaig
Linda F
LF
Ambulatory Care Statistics Branch, Division of Health Care Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD 20782, USA. lfm1@cdc.gov
McNeil
Michael M
MM
D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002181:Candidiasis, Vulvovaginal / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009819:Office Visits; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012651:Self Medication / Q000639:trends; D014481:United States
D000935:Antifungal Agents; D015725:Fluconazole