Terconazole

Use of Terconazole Cream for Vulvovaginal Candidiasis Candida species are responsible for up to half of all cases of vaginitis. An estimated 75 percent of women have vaginal candidiasis during their reproductive years. Several effective therapies are available, but treatment is inconvenient, and patient compliance is often poor. Shorter-duration regimens might minimize patient inconvenience and improve compliance.

In a double-blind, placebo-controlled study, Schmitt and colleagues evaluated the effectiveness of a three-day regimen of 0.8 percent or 1.6 percent terconazole cream in the treatment of severe vulvovaginal candidiasis.

Thirty-eight women were included in the study. All had symptoms of acute vaginitis and cultures positive for candidal infection. None of the women had received antimycotic therapy in the past two weeks. Patients who were pregnant and those younger than 18 years of age or older than 50 years of age were excluded from the study. Because the study was conducted in a university vaginitis clinic, the percentage of women with severe recurrent infections was greater than would normally be expected. More than 75 percent of the women had chronic, recalcitrant vulvovaginal candidiasis.

Patients were randomly assigned to receive 0.8 percent terconazole, 1.6 percent terconazole or placebo, inserted vaginally for three consecutive nights. Clinical and bacteriologic examinations were performed on day 1 to 3, day 8 to 10 and day 30 to 35.

At day-1 to -3 follow-up, cultures were negative in all of the 12 women treated with 1.6 percent terconazole and in 83 percent of the 12 women treated with 0.8 percent terconazole. In contrast, all of the 14 women receiving placebo continued to have positive cultures. This pattern persisted eight to 11 days after initiation of therapy. However, by 30 to 35 days after treatment, only 58 percent of the group treated with the 0.8 percent cream and 50 percent of the group treated with the 1.6 percent cream continued to have negative cultures.

With 1.6 percent terconazole and placebo, clinical success (as measured by patient perception of symptoms) matched or was higher than the mycologic cure rate at each follow-up visit. The clinical cure rate for 0.8 percent terconazole was lower than the mycologic cure rate at the first and second follow-up visits but higher at the final visit. Although there were slightly fewer clinical and mycologic failures in the group receiving 0.8 percent terconazole than in the group receiving the 1.6 percent cream, the difference was not statistically significant.

The study demonstrates that terconazole is a safe and effective short-term therapy for vulvovaginal candidiasis. However, maintenance therapy may be required after initially successful therapy in selected patients with recurrent vaginal candidiasis. (Obstetrics and Gynecology, September 1990, vol. 76, p. 414.)

COPYRIGHT 1991 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group