В обзоре представлены современные данные литературы о подходе к управлению вульвовагинальным кандидозом (ВВК). Показано, что основной современной тенденцией в управлении острым ВВК становится применение коротких курсов противогрибковой терапии с локальным использованием азолов. Фентиконазол в настоящее время является препаратом выбора в лечении ВВК, обладает высокой эффективностью и безопасностью. Ключевые слова: вульвовагинальный кандидоз, фентиконазол, Ломексин, лечение.
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The review presents the current data on the approach to the management of vulvovaginal candidosis (VVC). It is shown that the main current trend in the management of acute VVC is the use of short courses of antifungal therapy with a local application of azole. Fenticonazole is currently the drug of choice in the treatment of VVC has a high efficiency and safety. Key words: vulvovaginal cadndidosis, fenticonazole, Lomeksin, treatment.
1. Holland J, Young ML, Lee O, Chen S. Vulvovaginal carriage of yeasts other than Candida albicans. Sexually transmitted infections 2003; 79 (3): 249–50.
2. Sobel JD. Pathogenesis and epidemiology of vulvovaginal candidiasis. [Review]; [60 refs]. Ann NY Acad Sci 1988; 544: 547–57
3. Van Schalkwyk J, Yudin MH, Infectious Disease Committee et al. Vulvovaginitis: screening for and management of trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis. J Obstet Gynaecol Can 2015; 37 (3): 266–74.
4. European (IUSTI/WHO) Guideline on the Management of Vaginal Discharge 2011.
5. United Kingdom National Guideline on the Management of Vulvovaginal Candidiasis 2007.
6. STD Treatment Guidelines 2010.
7. Ferris DG, Dekle C, Litaker MS. Women's use of over-the-counter antifungal medications for gynecologic symptoms. J Fam Pract 1996; 42 (6): 595–600.
8. Кира Е.Ф., Беженарь В.Ф., Савичева А.М. Эффективность и безопасность сертаконазола (залаин) и натамицина (пимафуцин) в лечении острого урогенитального кандидоза у женщин. Акушерство и гинекология. 2007; 6: 50. / Kira E.F., Bezhenar' V.F., Savicheva A.M. Effektivnost' i bezopasnost' sertakonazola (zalain) i natamitsina (pimafutsin) v lechenii ostrogo urogenital'nogo kandidoza u zhenshchin. Akusherstvo i ginekologiia. 2007; 6: 50. [in Russian]
9. Савичева А.М. Лечение острого кандидозного вульвовагинита: современные тенденции. Акушерство и гинекология. 2010; 5: 59–62. / Savicheva A.M. Lechenie ostrogo kandidoznogo vul'vovaginita: sovremennye tendentsii. Akusherstvo i ginekologiia. 2010; 5: 59–62. [in Russian]
10. British Association of Sexual Health and HIV Clinical Effectiveness Group guidelines ‘Sexually Transmitted Infections: UK National Screening and Testing Guidelines’, August 2006 for comprehensive guidance. www.bashh.org/guidelines/2006/sti_screening_guidelines_v14_0806. Pdf
11. Mikamo H, Matsumizu M, Nakazuru Y et al. Efficacy and safety of a single oral 150 mg dose of fluconazole for the treatment of vulvovaginal candidiasis in Japan. J Infect Chemother 2015; pii: S1341-321X(15)00076-8. Doi: 10.1016/j.jiac.2015.03.011.
12. Li T, Zhu Y, Fan S et al. A randomized clinical trial of the efficacy and safety of terconazole vaginal suppository versus oral fluconazole for treating severe vulvovaginal candidiasis. Med Mycol 2015; pii: myv017.
13. Veronese M, Salvaterra M, Barzaghi D. Fenticonazole, a new imidazole derivative with antibacterial and antifungal activity. In vitro study. Arzneimittelforschung 1981; 31 (12): 2133–7.
14. Palacín C, Tarragó C, Agut J, Guglietta A. In vitro activity of sertaconazole, fluconazole, ketoconazole, fenticonazole, clotrimazole and itraconazole against pathogenic vaginal yeast isolates. Methods Find Exp Clin Pharmacol 2001; 23 (2): 61–4.
15. Hernández Molina JM, Llosá J et al. In vitro activity of cloconazole, sulconazole, butoconazole, isoconazole, fenticonazole, and five other antifungal agents against clinical isolates of Candida albicans and Candida spp. Mycopathologia 1992; 118 (1): 15–21.
16. Van Cutsem J. The in vitro activity of terconazole against yeasts: its topical long-acting therapeutic efficacy in experimental vaginal candidiasis in rats. Am J Obstet Gynecol 1991; 165 (4 Pt. 2): 1200–6.
17. Feng Z, Zou Q, Tan X et al. Determination of fenticonazole enantiomers by LC-ESI-MS/MS and its application to pharmacokinetic studies in female rats. Arzneimittelforschung 2011; 61 (10): 587–93.
18. VanCutsem J. The in vitro activity of terconazole against yeasts: its topical long-acting therapeutic efficacy in experimental vaginal candidiasis in rats. Am J Obstet Gynecol 1991; 165 (4 Pt. 2): 1200–6.
19. Feng Z, Zou Q, Tan X et al. Determination of fenticonazole enantiomers by LC-ESI-MS/MS and its application to pharmacokinetic studies in female rats. Arzneimittelforschung 2011; 61 (10): 587–93.
20. Van Cutsem J. The in vitro activity of terconazole against yeasts: its topical long-acting therapeutic efficacy in experimental vaginal candidiasis in rats. Am J Obstet Gynecol 1991; 165 (4 Pt. 2): 1200–6.
21. Kovachev S, Nacheva A, Vacheva-Dobrevska R, Vasilev N. Combined single-day treatment in acute vulvovaginal candidosis. AkushGinekol (Sofiia) 2009; 48 (6): 18–23.
22. Muzny CA, Schwebke JR. Biofilms: An Underappreciated Mechanism of Treatment Failure and Recurrence in Vaginal Infections. Clin Infect Dis 2015; pii: civ353. [Epub ahead of print]
23. Sobel JD. Vaginal Biofilm: Much Ado About Nothing, or a New Therapeutic Challenge? Clin Infect Dis 2015; pii: civ358. [Epub ahead of print]
24. Lawrence AG, Houang ET, Hiscock E et al. Single dose therapy of vaginal candidiasis: a comparative trial of fenticonazole vaginal ovules versus clotrimazole vaginal tablets. Curr Med Res Opin 1990; 12 (2): 114–20.
25. Studd JW, Dooley MM, Welch CC et al. Comparative clinical trial of fenticonazole ovule (600 mg) versus clotrimazole vaginal tablet
(500 mg) in the treatment of symptomatic vaginal candidiasis. Curr Med Res Opin 1989; 11 (8): 477–84.
26. MuñozReyes JR, Villanueva Reynoso C, Ramos CJ et al. Efficacy and tolerance of 200 mg fenticonazole versus 400 mg of miconazole in the intravaginal treatment of mycotic vulvovaginitis. Ginecol Obstet Mex 2002; 70: 59–65.
27. Fernández-Alba J, Valle-Gay A, Dibildox M et al. 2004. Fenticonazole nitrate for treatment of vulvovaginitis: efficacy, safety, and tolerability of 1-gram ovules, administered as ultra-short 2-day regimen. J Chemother 2044; 16: 179–86.
28. Gorlero F, Sartani A, Cordaro CI et al. Fenticonazole tissue levels after the application of 3 different dosage forms of vaginal ovules. Int J Clin Pharmacol Ther Toxicol 1988; 26 (10): 479–81.
29. Wiest W, Ruffmann R. Short-term treatment of vaginal candidiasis with fenticonazole ovules: a three-dose schedule comparative trial. J Int Med Res 1987; 15 (5): 319–25.
30. Радзинский В.Е., Артымук Н.В., Берлев И.В. и др. Рандомизированное многоцентровое исследование эффективности применения 600 и 1200 мг препарата Ломексин в лечении кандидозного вульвовагинита у женщин репродуктивного возраста. Акушерство и гинекология. 2013; 2: 113–8. / Radzinskii V.E., Artymuk N.V., Berlev I.V. i dr. Randomizirovannoe mnogotsentrovoe issledovanie effektivnosti primeneniia 600 i 1200 mg preparata Lomeksin v lechenii kandidoznogo vul'vovaginita u zhenshchin reproduktivnogo vozrasta. Akusherstvo i ginekologiia. 2013; 2: 113–8. [in Russian]
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1. Holland J, Young ML, Lee O, Chen S. Vulvovaginal carriage of yeasts other than Candida albicans. Sexually transmitted infections 2003; 79 (3): 249–50.
2. Sobel JD. Pathogenesis and epidemiology of vulvovaginal candidiasis. [Review]; [60 refs]. Ann NY Acad Sci 1988; 544: 547–57
3. Van Schalkwyk J, Yudin MH, Infectious Disease Committee et al. Vulvovaginitis: screening for and management of trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis. J Obstet Gynaecol Can 2015; 37 (3): 266–74.
4. European (IUSTI/WHO) Guideline on the Management of Vaginal Discharge 2011.
5. United Kingdom National Guideline on the Management of Vulvovaginal Candidiasis 2007.
6. STD Treatment Guidelines 2010.
7. Ferris DG, Dekle C, Litaker MS. Women's use of over-the-counter antifungal medications for gynecologic symptoms. J Fam Pract 1996; 42 (6): 595–600.
8. Kira E.F., Bezhenar' V.F., Savicheva A.M. Effektivnost' i bezopasnost' sertakonazola (zalain) i natamitsina (pimafutsin) v lechenii ostrogo urogenital'nogo kandidoza u zhenshchin. Akusherstvo i ginekologiia. 2007; 6: 50. [in Russian]
9. Savicheva A.M. Lechenie ostrogo kandidoznogo vul'vovaginita: sovremennye tendentsii. Akusherstvo i ginekologiia. 2010; 5: 59–62. [in Russian]
10. British Association of Sexual Health and HIV Clinical Effectiveness Group guidelines ‘Sexually Transmitted Infections: UK National Screening and Testing Guidelines’, August 2006 for comprehensive guidance. www.bashh.org/guidelines/2006/sti_screening_guidelines_v14_0806. Pdf
11. Mikamo H, Matsumizu M, Nakazuru Y et al. Efficacy and safety of a single oral 150 mg dose of fluconazole for the treatment of vulvovaginal candidiasis in Japan. J Infect Chemother 2015; pii: S1341-321X(15)00076-8. Doi: 10.1016/j.jiac.2015.03.011.
12. Li T, Zhu Y, Fan S et al. A randomized clinical trial of the efficacy and safety of terconazole vaginal suppository versus oral fluconazole for treating severe vulvovaginal candidiasis. Med Mycol 2015; pii: myv017.
13. Veronese M, Salvaterra M, Barzaghi D. Fenticonazole, a new imidazole derivative with antibacterial and antifungal activity. In vitro study. Arzneimittelforschung 1981; 31 (12): 2133–7.
14. Palacín C, Tarragó C, Agut J, Guglietta A. In vitro activity of sertaconazole, fluconazole, ketoconazole, fenticonazole, clotrimazole and itraconazole against pathogenic vaginal yeast isolates. Methods Find Exp Clin Pharmacol 2001; 23 (2): 61–4.
15. Hernández Molina JM, Llosá J et al. In vitro activity of cloconazole, sulconazole, butoconazole, isoconazole, fenticonazole, and five other antifungal agents against clinical isolates of Candida albicans and Candida spp. Mycopathologia 1992; 118 (1): 15–21.
16. Van Cutsem J. The in vitro activity of terconazole against yeasts: its topical long-acting therapeutic efficacy in experimental vaginal candidiasis in rats. Am J Obstet Gynecol 1991; 165 (4 Pt. 2): 1200–6.
17. Feng Z, Zou Q, Tan X et al. Determination of fenticonazole enantiomers by LC-ESI-MS/MS and its application to pharmacokinetic studies in female rats. Arzneimittelforschung 2011; 61 (10): 587–93.
18. VanCutsem J. The in vitro activity of terconazole against yeasts: its topical long-acting therapeutic efficacy in experimental vaginal candidiasis in rats. Am J Obstet Gynecol 1991; 165 (4 Pt. 2): 1200–6.
19. Feng Z, Zou Q, Tan X et al. Determination of fenticonazole enantiomers by LC-ESI-MS/MS and its application to pharmacokinetic studies in female rats. Arzneimittelforschung 2011; 61 (10): 587–93.
20. Van Cutsem J. The in vitro activity of terconazole against yeasts: its topical long-acting therapeutic efficacy in experimental vaginal candidiasis in rats. Am J Obstet Gynecol 1991; 165 (4 Pt. 2): 1200–6.
21. Kovachev S, Nacheva A, Vacheva-Dobrevska R, Vasilev N. Combined single-day treatment in acute vulvovaginal candidosis. AkushGinekol (Sofiia) 2009; 48 (6): 18–23.
22. Muzny CA, Schwebke JR. Biofilms: An Underappreciated Mechanism of Treatment Failure and Recurrence in Vaginal Infections. Clin Infect Dis 2015; pii: civ353. [Epub ahead of print]
23. Sobel JD. Vaginal Biofilm: Much Ado About Nothing, or a New Therapeutic Challenge? Clin Infect Dis 2015; pii: civ358. [Epub ahead of print]
24. Lawrence AG, Houang ET, Hiscock E et al. Single dose therapy of vaginal candidiasis: a comparative trial of fenticonazole vaginal ovules versus clotrimazole vaginal tablets. Curr Med Res Opin 1990; 12 (2): 114–20.
25. Studd JW, Dooley MM, Welch CC et al. Comparative clinical trial of fenticonazole ovule (600 mg) versus clotrimazole vaginal tablet
(500 mg) in the treatment of symptomatic vaginal candidiasis. Curr Med Res Opin 1989; 11 (8): 477–84.
26. MuñozReyes JR, Villanueva Reynoso C, Ramos CJ et al. Efficacy and tolerance of 200 mg fenticonazole versus 400 mg of miconazole in the intravaginal treatment of mycotic vulvovaginitis. Ginecol Obstet Mex 2002; 70: 59–65.
27. Fernández-Alba J, Valle-Gay A, Dibildox M et al. 2004. Fenticonazole nitrate for treatment of vulvovaginitis: efficacy, safety, and tolerability of 1-gram ovules, administered as ultra-short 2-day regimen. J Chemother 2044; 16: 179–86.
28. Gorlero F, Sartani A, Cordaro CI et al. Fenticonazole tissue levels after the application of 3 different dosage forms of vaginal ovules. Int J Clin Pharmacol Ther Toxicol 1988; 26 (10): 479–81.
29. Wiest W, Ruffmann R. Short-term treatment of vaginal candidiasis with fenticonazole ovules: a three-dose schedule comparative trial. J Int Med Res 1987; 15 (5): 319–25.
30. Radzinskii V.E., Artymuk N.V., Berlev I.V. i dr. Randomizirovannoe mnogotsentrovoe issledovanie effektivnosti primeneniia 600 i 1200 mg preparata Lomeksin v lechenii kandidoznogo vul'vovaginita u zhenshchin reproduktivnogo vozrasta. Akusherstvo i ginekologiia. 2013; 2: 113–8. [in Russian]
Авторы
Н.В.Артымук*, В.И.Черняева
ГБОУ ВПО Кемеровская государственная медицинская академия Минздрава России.
650029, Россия, Кемерово, ул. Ворошилова, д. 22а
*artymuk@gmail.com
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N.V.Artymuk*, V.I.Chernyaeva
Kemerovo State Medical Academy of the Ministry of Health of the Russian Federation.
650029, Russian Federation, Kemerovo, ul. Voroshilova, d. 22a
*artymuk@gmail.com