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Fluconazole-Resistant Vulvovaginal Candidosis: An Update on Current Management
Karolina Akinosoglou1,2, Achilleas Livieratos3, Konstantinos Asimos4
1Department of Medicine, University of Patras, 265 04 Rio, Greece.
Abstract:
Currently, the rising prevalence of resistant Candida species, particularly Candida albicans, as well as non-albicans isolates such as Candida glabrata and Candida krusei, represent challenges in their management. In this review, we aimed to explore the current management of fluconazole-resistant vulvovaginal candidiasis (FRVVC). Identified studies focused on alternative antifungal therapies, including boric acid, nystatin, and newer agents like oteseconazole and ibrexafungerp. The findings highlight the need for tailored treatment regimens, considering the variability in resistance patterns across regions. Unprofessional as well as professional overuse of antifungals for vulvovaginal symptoms that are not caused by Candida infections should be combatted and banned as much as possible. Instead of high-dose maintenance regimens using weekly doses of 150 to 200 mg of fluconazole for 6 months or longer, it is advisable to use an individualised degressive regimen (ReCiDiF regimen) in order to tailor the treatment of a particular patient to the lowest dosage possible to keep the diseases controlled. Additionally, this report underscores the impact of antibiotic use on the microbiota, which can raise the possibility of VVC and lead to fluconazole resistance, emphasizing the necessity for cautious antibiotic prescribing practices.
Insights
Managing fluconazole-resistant vulvovaginal candidiasis (FRVVC) requires exploring alternative antifungals and individualized treatment. Avoiding unnecessary antifungal use and cautious antibiotic prescribing are crucial for effective VVC management.
Area of Science:
- Mycology
- Infectious Diseases
- Pharmacology
Background:
- Rising prevalence of resistant *Candida* species (*Candida albicans*, *Candida glabrata*, *Candida krusei*) poses management challenges.
- Fluconazole-resistant vulvovaginal candidiasis (FRVVC) necessitates alternative therapeutic strategies.
- Antifungal overuse for non-*Candida* infections contributes to resistance and treatment failures.
Purpose of the Study:
- To review current management strategies for fluconazole-resistant vulvovaginal candidiasis (FRVVC).
- To explore alternative antifungal therapies and treatment regimens.
- To emphasize the impact of antibiotic use on microbiota and antifungal resistance.
Main Methods:
- Literature review of studies on FRVVC management.
- Identification of alternative antifungal agents (e.g., boric acid, nystatin, oteseconazole, ibrexafungerp).
- Analysis of treatment regimens, including individualized degressive (ReCiDiF) approaches.
Main Results:
- Alternative therapies show promise for FRVVC.
- Tailored treatment regimens are essential due to regional resistance variability.
- The ReCiDiF regimen offers a personalized approach to minimize dosage and control infection.
- Antibiotic use can disrupt microbiota, increasing VVC risk and promoting fluconazole resistance.
Conclusions:
- Effective FRVVC management requires a shift from high-dose maintenance to individualized, degressive treatment.
- Judicious use of antifungals and antibiotics is critical to combat resistance and preserve microbiota.
- Further research into novel agents and treatment strategies is warranted.
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