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Objectives: To compare efficacy, acceptability and patient preference of a single oral dose of fluconazole with a single intravaginal dose of 500 mg clotrimazole (medication groups) in women with vaginal candidosis visiting gynaecologists or general practitioners (study groups)., Design: A comparative, randomized multicenter study. EVENTS: Baseline visit and treatment, short-term follow-up after 1 week and long-term follow-up after 4 weeks. At each visit, symptoms were graded and cultures were obtained., Results: Symptomatic and mycological efficacy did not differ statistical significant in the medication groups or study groups. A complicated history regarding vaginal candidosis was more often found among gynaecologists, yielding poorer results of treatment. Patients preferred oral treatment over intra-vaginal treatment., Conclusions: No differences were found in the clinical and mycological efficacy of both drugs. Clinical results were related to parameters originating from the patients history, resulting in less favourable results in the study group of gynaecologists.

Fluor vaginalis may have a diversity of causes, among which are fungal infections by Candida spp. It has been estimated that up to 75% of women will have at least one episode of vaginal candidosis during their reproductive years. Most of these women have had only one occasional episode of discomfort. However, a small group presents with a chronic recurrence of vaginal candidosis accompanied by symptomatic infections many times a year. Until now, investigations into the pathogenesis and treatment of these recurrent episodes gave no clear answer to the question as to why this occurs in these patients. The opportunity to treat vaginal candidosis with a systemic antifungal drug can have advantages over a topical drug, if extravaginal Candida spp. that may contribute to recurrence can be eliminated at the same time. In this trial, 18 patients with chronic recurrent vaginal candidosis (greater than 4 attacks of candidosis vaginalis per year) were treated with itraconazole 200 mg/day monthly for two days--Days 5 and 6 after menstruation. After the first therapeutic treatment, 17 patients were culture-negative and symptom-free. Results show that prophylaxis for six months with itraconazole was beneficial, as far as complaints were concerned, in 11 patients (64.7%).

Research into the pathogenesis and treatment of chronic recurrent candidosis vaginalis did not come up with a clear answer of curing this phenomenon. In this investigation, data are presented of a therapy with a new antifungal agent, itraconazole. After a therapeutic treatment course, 17 patients received a prophylaxis for CRCV over 6 months. The treatment schedule for prophylaxis consisted of 4 capsules of 50 mg itraconazole on day 5 and 6 of the menstrual cycle. Eleven remained symptom-free in this period. Although there is no explanation for recurrence in most cases of CRCV, intermittent treatment schedules can be used to treat but not to cure these patients. Data of this investigation and data mentioned in the literature prove the necessity to discriminate between a sympatomtic and a mycological cure.

Objectives: To compare efficacy, safety and patient preference of a single oral dose of 150 mg fluconazole with a single intravaginal dose of 1200 mg miconazole in vaginal candidosis. To investigate the effect of treatment on Candida colonization of throat and rectum., Design: Double-blind, double-dummy, parallel, randomized trial. Ninety-nine patients with symptomatic and mycologically verified candidosis were given 150 mg fluconazole with an intravaginal dummy, or 1200 mg miconazole with an oral dummy. Patients with an inadequate short-term response were given a second dose., Results: At each visit a patient self assessment and an investigators' global assessment were recorded, and cultures were set up. Adverse events were recorded and laboratory tests were performed. Clinical cure or improvement (investigators' assessment) was obtained in 100% (short-term) and 95% (long term) of the fluconazole group and in 94% and 90%, respectively, of the miconazole group. Patients considered the treatment excellent or good in 81% (short-term) and 88% (long-term) in the fluconazole group and in 84% and 76%, respectively, of the miconazole group. Mycological cure was achieved in 98% (short-term) and 73% (long-term) of the fluconazole group and in 96% and 82% respectively in the miconazole group. The differences in results were not significant. Both treatments significantly reduced the number of positive rectal cultures: neither treatment had a significant effect on throat cultures. Four percent of the patients preferred intravaginal therapy., Conclusion: A single dose fluconazole is as safe and effective as a single dose of miconazole.