Long-term outcomes of prolonged fenticonazole therapy in patients with recurrent vulvovaginal candidiasis

Objective: To study the effect of a prolonged course of topical therapy with fenticonazole for the prevention of recurrent vulvovaginal candidiasis in patients with the chronic recurrent course of the disease and to evaluate the recurrence-free course of vulvovaginal candidiasis during the following 6 months.

Materials and methods: The study included 206 female patients with recurrent vulvovaginal candidiasis. The patients received the following treatment: fenticonazole 600 mg topically was prescribed twice at 72 h intervals to the patients of the main group (n=96); then the patients of the 1st subgroup (n=36) received fenticonazole 600 mg once every 10 days for 3 months; the patients of the 2nd subgroup (n=30) received fenticonazole 600 mg twice at 72 h intervals once a month for 3 months; the patients of the 3rd subgroup (n=30) received fenticonazole 600 mg once every 10 days followed by two courses of PRP-therapy. The patients in the control group (n=110) were prescribed fluconazole 150 mg orally on days 1, 4 and 7, then 150 mg once a week for 3 months. The patients of the groups were comparable in age, body mass index, somatic and gynecologic diseases. The women were followed up for 3 months of maintenance therapy and then 6 months after the end of the treatment.

Results: There were no significant differences in the rate of recurrent vulvovaginal candidiasis in patients receiving systemic and topical therapy (p=0.66), but during a 3-month follow-up the rate of recurrence was considerably higher in the group of patients who received systemic treatment with fluconazole (p=0.043). The efficacy of therapy was 92.71% in the main group and there were no subsequent recurrences during the next 3 months in 87.5% of the patients. The efficacy of therapy was 94.55% in the control group, and there were no recurrences in 76.36% of the patients during the next 3 months. Recurrences were noted in 34.3% (33/96) of patients in the main group in 6 months after the end of the course of maintenance therapy, and recurrences were observed in almost every second case in the control group, namely, in 46.4% (51/110), respectively (p=0.039).

Conclusion: Topical and systemic therapy are equally effective in the treatment of recurrent vulvovaginal candidiasis. The rate of recurrence after the end of the treatment was significantly lower after topical use of fenticonazole compared to systemic administration of fluconazole.