Usage of antifungal drugs for therapy of genital Candida infections, purchased as over-the-counter products or by prescription: 2. Factors that may have influenced the marked changes in sales volumes during the 1990s.
BACKGROUND
The epidemiology of vulvovaginal candidiasis (VVC) and such recurrent infections (RVVC) has been difficult to study as the majority of episodes of these conditions are self-treated by the women affected. In Sweden, all pharmacies are owned by the state and all prescriptions and over-the-counter (OTC) products, such as antifungals, are registered in a database, which offers unique possibilities to study the epidemiology of VVC/RVVC.


OBJECTIVE
To analyze all prescriptions and OTC products purchased for therapy of VVC/RVVC and to establish reasons for any observed variation in the sales figures.


METHODS
Sales figures in the Swedish county of Skåne of antifungal drugs for therapy of VVC/RVVC were analyzed by the aid of the 'ACS' database of the National Corporation of Swedish Pharmacies for the years 1990--1999. The size of the female population in the county is approximately half a million.


RESULTS
The study showed that 93% of all antifungal drugs for VVC/RVVC were sold as OTC products. An increase in sales of the drugs occurred until mid- 1993/94, followed by a decrease until end of the study period in 1999. Demographic factors (e.g. the number of female inhabitants in the county, pharmacies and health-care units), the pregnancy rate and pharmacy-dependent factors (such as the introduction of shelves for self-selection of antifungal products) did not explain the observed variations in sales. Distinct short-term variations in the number of prescriptions of fluconazole and itraconazole could be explained by drugs company sales campaigns and logistics factors in drug distribution. The sales volumes in the 33 municipalities in the county correlated with the density of the population, which was not the case for the total number of prescriptions made in the county during the 1990s. The variation in antifungal drug sales was similar to that of hormonal intrauterine devices, but this was not the case for oral contraceptives. The total Swedish usage of antibiotics showed a similar variation to that of the antifungal drugs analyzed.


CONCLUSIONS
The study stresses the limited impact on the treatment of VVC/RVVC by the medical community. Behavior-related factors in the female population are the most likely explanation for the marked variations found in the usage of drugs for the two conditions.
Mårdh
Per-Anders
PA
Department of Obstetrics and Gynaecology, University Hospital, Lund, Sweden. per-anders.mardh@gyn.lu.se
Wågström
Jolanta
J
Landgren
Maria
M
Holmén
Jan
J
D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage*; D001393:Azoles / Q000008:administration & dosage; D002181:Candidiasis, Vulvovaginal / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D019992:Databases as Topic; D003710:Demography; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D008875:Middle Aged; D004366:Nonprescription Drugs; D010594:Pharmacies / Q000639:trends*; D012008:Recurrence; D012424:Rural Population; D012651:Self Medication; D012725:Sexual Behavior; D013548:Sweden / Q000453:epidemiology; D014505:Urban Population
D000935:Antifungal Agents; D001393:Azoles; D004366:Nonprescription Drugs
BJOG. 2003 Oct;110(10):934-7
14550364
Obstet Gynecol. 1980 Jul;56(1):121-3
7383476
J Med Microbiol. 2000 Sep;49(9):831-40
10966233
Sex Transm Infect. 1998 Oct;74(5):334-8
10195028
Am J Obstet Gynecol. 1999 Aug;181(2):367-70
10454684
Fam Pract. 2000 Apr;17(2):145-9
10758077
APMIS. 1999 Nov;107(11):1020-2
10598874
Int J STD AIDS. 2002 Aug;13(8):522-39
12194734
Antimicrob Agents Chemother. 1984 Feb;25(2):281-2
6324671
Rev Infect Dis. 1987 Jan-Feb;9 Suppl 1:S143-5
3027841
Int J Gynaecol Obstet. 1998 Nov;63(2):145-52
9856320
Obstet Gynecol. 1998 Nov;92(5):757-65
9794664
Am J Obstet Gynecol. 1998 Feb;178(2):203-11
9500475
Epidemiology. 1996 Mar;7(2):182-7
8834559
J Antimicrob Chemother. 1993 Sep;32(3):355-65
8262858
Arch Intern Med. 1990 Sep;150(9):1929-33
2393324