Management of persistent vulvo vaginal candidosis due to azole-resistant Candida glabrata

Genitourin Med. 1993 Apr;69(2):112-4. doi: 10.1136/sti.69.2.112.

Abstract

CASE REPORT--SUBJECTS--Three cases are described of long-standing vaginal candidosis due to Candida glabrata. These had failed to respond to local and systemic antifungals. In each case the infecting strain appeared resistant to a range of azole drugs in vitro. CLINICAL COURSE--Case one--This patient recovered following prolonged treatment with oral itraconazole in combination with oral and vaginal nystatin. Case two. Yeasts were eradicated from this patient following cyclical treatment with oral dydrogesterone; prolonged vaginal treatment with nystatin may have helped. Case three. This patient did not respond to a prolonged course of oral itraconazole in combination with vaginal and oral nystatin, oral medroxyprogesterone or intravaginal boric acid. Eradication of C glabrata was finally achieved by local application of 1% gentian violet. Shortly after eradication of the C glabrata infection, both Case two and Case three developed infections with other Candida species responsive to azole antifungals.

Publication types

  • Case Reports

MeSH terms

  • Administration, Oral
  • Administration, Topical
  • Adult
  • Antifungal Agents / therapeutic use*
  • Candidiasis, Vulvovaginal / drug therapy*
  • Drug Resistance, Microbial
  • Econazole / therapeutic use
  • Female
  • Fluconazole / therapeutic use
  • Gentian Violet / therapeutic use
  • Humans
  • Itraconazole
  • Ketoconazole / analogs & derivatives
  • Ketoconazole / therapeutic use
  • Medroxyprogesterone Acetate / therapeutic use
  • Microbial Sensitivity Tests
  • Nystatin / therapeutic use

Substances

  • Antifungal Agents
  • Nystatin
  • Itraconazole
  • Econazole
  • Fluconazole
  • Medroxyprogesterone Acetate
  • Gentian Violet
  • Ketoconazole