Clinical resistance of recurrent Candida albicans vulvovaginitis to fluconazole in the presence and absence of in vitro resistance.

Abstract

OBJECTIVE:

To determine if failure of recurrent Candida albicans vulvovaginitis to respond clinically to fluconazole is related to in vitro mycologic resistance.

STUDY DESIGN:

We compared clinical response to fluconazole with culture and sensitivity data in all cases of recurrent C albicans vulvovaginitis referred to our clinic over an 18-month period.

RESULTS:

Of 52 patients referred to us with recurring vulvovaginitis, 10 were C albicans culture positive. All 10 had previously responded to fluconazole but subsequently failed fluconazole therapy. All were euglycemic and HIV negative. In 3 of the 10 isolates, the mean inhibitory concentration for fluconazole was > 64 micrograms/mL. The history of response to fluconazole in the 7 patients with susceptible isolates was indistinguishable from that of the 3 with resistant isolates. Five of the 10 patients were given multiagent antifungal therapy. Of 4 patients available for long-term follow-up in this group, all had negative fungal cultures. In contrast, 4 evaluable patients who received maintenance azole therapy were C albicans culture positive at long-term follow-up.

CONCLUSION:

Recurrent C albicans vulvovaginitis can display clinical resistance to fluconazole that correlates with in vitro resistance in only some cases. We postulate that aberrant host response may play a role in the failure to control fungal colonization with a single fungistatic agent.

• Authors: Colin MacNeill, Judith Weisz, J Christopher Carey
• Journal: The Journal of reproductive medicine (J Reprod Med) Vol. 48 Issue 2 Pg. 63-8 (Feb 2003) ISSN: 0024-7758 [Print] United States
• PMID: 12621787 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Antifungal Agents
• Fluconazole

Topics

• Adolescent
• Adult
• Antifungal Agents (pharmacology)
• Candida albicans (drug effects, isolation & purification)
• Candidiasis (diagnosis, drug therapy)
• Cohort Studies
• Drug Resistance, Fungal
• Female
• Fluconazole (pharmacology, therapeutic use)
• Follow-Up Studies
• Humans
• Microbial Sensitivity Tests
• Middle Aged
• Prospective Studies
• Recurrence
• Risk Assessment
• Treatment Outcome
• Vulvovaginitis (drug therapy, microbiology)