Monthly itraconazole versus classic homeopathy for the treatment of recurrent vulvovaginal candidiasis: a randomised trial.
OBJECTIVE
Antimycotics effectively treat sporadic and recurrent vulvovaginal candidiasis (RVVC). Classic homeopathy (CH) is also used to treat this condition. We compared the efficacy of CH and itraconazole in reducing the frequency of RVVC episodes.


METHODS
Single-centre, prospective, randomised trial.


METHODS
One hundred-and-fifty patients with a history of RVVC and an acute episode of VVC.


METHODS
Women were randomised into 3 groups: itraconazole with lactobacilli (group 1), itraconazole without lactobacilli (group 2) and CH (group 3). Itraconazole treatment of acute infection was followed by a 6-month maintenance regimen with monthly single-day itraconazole (200 mg bid). Women in group 1 were given additional vaginal lactobacilli for 6 days per month throughout the maintenance regimen Thereafter, patients were followed without treatment for 6 months. CH treatment was performed for 12 months.


RESULTS
Women in groups 1 and 2 reached a culture-free status significantly earlier than women in group 3 (log-rank test; P < 0.0001). Specifically, before the start of the maintenance regimen, 44 of 49 women (89.8%) in group 1 and 40 of 47 women (85%) in group 2 were free of Candida detectable by culture, 22 of 46 (47%) women in group 3 reached a culture-free status after the first visit, but had a recurrence significantly earlier compared with women in groups 1 and 2 (log-rank test; P = 0.002). After 12 months, 19 of 25 (76%) women in group 1, 18 of 23 (78%) women in group 2 and 9 of 23 (39%) women in group 3 were free of culture-detectable Candida. Assessment of RVVC-associated complaints by VAS score showed that women in group 3 had a significantly higher level of discomfort (36.8, 25.1 and 27.7 respectively; P < 0.001) and were significantly less satisfied (59.2, 68.2 and 71.7 respectively; P < 0.001) than patients in groups 1 and 2.


CONCLUSIONS
Monthly cycle-dependent itraconazole is more effective than CH in the treatment of RVVC. Lactobacilli do not confer an added benefit.
Witt
A
A
Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria. armin.witt@meduniwien.ac.at
Kaufmann
U
U
Bitschnau
M
M
Tempfer
C
C
Ozbal
A
A
Haytouglu
E
E
Gregor
H
H
Kiss
H
H
D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D001317:Austria; D002181:Candidiasis, Vulvovaginal / Q000628:therapy*; D004334:Drug Administration Schedule; D005260:Female; D006705:Homeopathy; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use*; D007778:Lactobacillus; D008597:Menstrual Cycle; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012646:Self Administration; D016896:Treatment Outcome; D055815:Young Adult
D000935:Antifungal Agents; D017964:Itraconazole