COMPARATIVE STUDY OF ORAL VERSUS LOCAL TREATMENT OF VAGINAL CANDIDIASIS

Abstract

Background: Vaginal candidiasis is a fungus that is known to cause high morbidity, recurrent disease, and poor quality of life in women of reproductive age. Despite the widespread use of first-line treatments with oral fluconazole and vaginal clotrimazole, there is still no consistency in the comparison of their clinical and mycological effects in various populations. Aim: To compare the efficacy of oral fluconazole and vaginal clotrimazole cream in the treatment of women with vaginal candidiasis. Methods: A randomized controlled trial was done in Gulab Devi Hospital, Lahore. Non-probability consecutive sampling was used to recruit 62 women aged 18 50 years with clinically diagnosed vaginal candidiasis who were randomly randomized to either of the two groups. Group A was dosed with fluconazole 150 mg (one time orally) and Group B with clotrimazole vaginal cream (5 g a day at bedtime during seven days). The participants were assessed at 7-10 days, 30-35 days and three months to evaluate the clinical and mycological outcome. The data was analyzed with the help of IBM SPSS version 22 and the p less than 0.05 was viewed as statistically significant. Results: The baseline demographics and clinical features were the same in the two treatment groups (p > 0.05). Full clinical cure was seen in 87.1% of vaginally placed clotrimazole and 74.2% of orally administered fluconazole (p = 0.041) and mycological cure in 90.3% and 77.4%, respectively, at 7-10 days. By 30-35 days, the clinical cure rate was higher in vaginal clotrimazole group (93.5% and 80.6%) than in the control oral fluconazole group (p = 0.041) with the mycological cure being 96.8% and 83.9% respectively. Within the three months follow up, women who were treated with vaginal clotrimazole had had sustained clinical cure at 90.3% as compared to women who were treated with oral fluconazole, which was at 77.4 and recurrence rates were at 6.5% as compared to 19.4% respectively (p = 0.047, and p = 0.039 respectively). Conclusion: Both oral fluconazole and vaginal clotrimazole successfully treated vaginal candidiasis, but vaginal clotrimazole showed slightly better clinical and mycological effects and a reduced recurrence during follow-up. Therefore, bigger multicenter randomized studies are necessary to verify these findings.