Background: Vulvovaginal Candidiasis (VVC) is one of the frequent infections of the female genital tract and is the second most common cause of vaginal infections after bacterial vaginosis. According to the Centers for Disease Control and Prevention, azoles are the first‑line treatment for VVC. Among the azoles available in the Philippines, only miconazole and clotrimazole are recommended for both pregnant and non‑pregnant women. Objective: Compare the effect of miconazole versus clotrimazole in the treatment of vulvovaginal candidiasis among patients seen at the out‑patient department in a tertiary hospital Materials and Methods: This involved review of the records of patients diagnosed with VVC in a tertiary medical center from 2016 to 2020. All records of women, pregnant and non‑pregnant, wherein single‑dose 1200 mg miconazole or 6‑day 100 mg clotrimazole given vaginally were included Results: Eleven out of the 316 records (3.46%) remained symptomatic after treatment, about 18.1% (2/161) from those who used miconazole and 81.8% (9/155) from those treated with clotrimazole (p 0.027). In terms of failure rate, for miconazole it was 1.2% (2/161), whereas for clotrimazole it was 5.8% (9/155). None of the charts were found to have recorded adverse reaction to the given treatment Conclusion Single‑dose miconazole intravaginal regimen has a higher clinical cure rate than the 6‑day clotrimazole intravaginal treatment. Thereby, single‑dose intravaginal miconazole has the potential to improve patient compliance and treatment outcome at a lower cost
Clotrimazole ; Miconazole ; Vaginitis ; Candidiasis, Vulvovaginal

BACKGROUNDVulvovaginal candidiasis (VVC) was a common infection associated with lifelong harassment of woman's social and sexual life. The purpose of this study was to describe the species distribution and in vitroCandidaCandida spp.) isolated from patients with VVC over 8 years.

METHODSSpecies which isolated from patients with VVC in Peking University First Hospital were identified using chromogenic culture media. Susceptibility to common antifungal agents was determined using agar diffusion method based on CLSI M44-A2 document. SPSS software (version 14.0, Inc., Chicago, IL, USA) was used for statistical analysis, involving statistical description and Chi-square test.

RESULTSThe most common strains were Candida (C.) albicans, 80.5% (n = 1775) followed by C. glabrata, 18.1% (n = 400). Nystatin exhibited excellent activity against all species (<4% resistant [R]). Resistance to azole drugs varied among different species. C. albicans: clotrimazole (3.1% R) < fluconazole (16.6% R) < itraconazole (51.5% R) < miconazole (54.0% R); C. glabrata: miconazole (25.6% R) < clotrimazole (50.5% R) < itraconazole (61.9% R) < fluconazole (73.3% R); Candida krusei: clotrimazole (0 R) < fluconazole (57.7% R) < miconazole (73.1% R) < itraconazole (83.3% R). The susceptibility of fluconazole was noticeably decreasing among all species in the study period.

CONCLUSIONSNystatin was the optimal choice for the treatment of VVC at present. The species distribution and in vitroCandida spp. isolated from patients with VVC had changed over time.

Antifungal Agents ; pharmacology ; Candida ; drug effects ; pathogenicity ; Candidiasis, Vulvovaginal ; microbiology ; China ; Clotrimazole ; pharmacology ; Drug Resistance, Fungal ; Female ; Fluconazole ; pharmacology ; Humans ; Itraconazole ; pharmacology ; Miconazole ; pharmacology ; Microbial Sensitivity Tests

BACKGROUND/OBJECTIVES: Reactive oxygen species (ROS) formation is closely related to miconazole-induced heart dysfunction. Although rhamnetin has antioxidant effects, it remained unknown whether it can protect against miconazole-induced cardiomyocyte apoptosis. Thus, we investigated the effects of rhamnetin on miconazole-stimulated H9c2 cell apoptosis. MATERIALS/METHODS: Cell morphology was observed by inverted microscope and cell viability was determined using a WelCount(TM) cell proliferation assay kit. Miconazole-induced ROS production was evaluated by fluorescence-activated cell sorting with 6-carboxy-2',7'-dichlorofluoroscein diacetate (H2DCF-DA) stain. Immunoblot analysis was used to determine apurinic/apyrimidinic endonuclease 1 (APE/Ref-1) and cleaved cysteine-aspartic protease (caspase) 3 expression. NADPH oxidase levels were measured using real-time polymerase chain reaction. RESULTS: Miconazole (3 and 10 microM) induced abnormal morphological changes and cell death in H9c2 cells. Rhamnetin enhanced the viability of miconazole (3 microM)-treated cells in a dose-dependent manner. Rhamnetin (1 and 3 microM) treatment downregulated cleaved caspase 3 and upregulated APE/Ref-1 expression in miconazole-stimulated cells. Additionally, rhamnetin significantly reduced ROS generation. CONCLUSIONS: Our data suggest that rhamnetin may have cytoprotective effects in miconazole-stimulated H9c2 cardiomyocytes via ROS inhibition. This effect most likely occurs through the upregulation of APE/Ref-1 and attenuation of hydrogen peroxide levels.
Antioxidants ; Apoptosis ; Caspase 3 ; Cell Death ; Cell Proliferation ; Cell Survival ; Flow Cytometry ; Heart ; Hydrogen Peroxide ; Miconazole ; Myocytes, Cardiac ; NADPH Oxidase ; Reactive Oxygen Species ; Real-Time Polymerase Chain Reaction ; Up-Regulation

INTRODUCTIONThis study aims to determine the incidence, trends of systemic candidiasis and meningitis in extremely low birthweight (ELBW) neonates (<1000 gms) despite the routine use of topical miconazole prophylaxis and to compare the risk factors, adverse outcomes and comorbidities with controls.

MATERIALS AND METHODSRetrospective cohort study of ELBW neonates with systemic candidiasis and meningitis over an 11-year period (1997 to 2007). Matched case control analyses were performed to determine the risk factors and comorbidities which were severe intraventricular haemorrhage (IVH), severe retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) requiring treatment, necrotising enterocolitis (NEC), chronic lung disease (CLD) and cholestatic jaundice. Mortality and end organ involvement secondary to systemic candidiasis were identified as adverse outcomes.

RESULTSOf the 757 ELBW neonates, 51 (6.7%) had evidence of systemic candidiasis with a significant 3-fold increase in trend noted in 2007 as compared against 1997 (12.1% vs 3.8%) (RR 1.2, 95% CI, 1.06 to 1.36, P <0.001). This corresponds to a significant increasing trend of preceding or co-existent bacterial blood stream infections (BSI) in neonates with systemic candidiasis (0% in 1997 vs 7.1% in 2007, RR 1.40, 95% CI, 1.04 to 1.25, P = 0.005). On logistic regression analysis, decreasing gestational age was an independent risk factor for systemic candidiasis (OR 2.0, 95% CI, 1.52 to 2.63, P <0.001). Candida meningitis was detected in 4/38 (10.5%) and end organ involvement in 17 (33%). The organisms isolated were Candida parapsilosis 31 (61%), Candida albicans 17 (33%) and Candida glabrata 3 (5.8%). Significantly higher mortality was seen in cases when compared to controls 10/51 (19.6%) vs 76/706 (10.7%) (OR 2.02, 95% CI, 1.02 to 4.40, P <0.001).

CONCLUSIONIncreasing trend in the incidence of systemic candidiasis despite routine use of topical miconazole prophylaxis is of concern and future studies comparing the use of systemic fl uconazole versus oral nystatin may need to be considered.

Administration, Topical ; Antifungal Agents ; administration & dosage ; Candidiasis ; epidemiology ; prevention & control ; Cohort Studies ; Humans ; Incidence ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Miconazole ; administration & dosage ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Failure

Clinical features of the dermatophyte infections of the glabrous skin can be altered by inappropriate treatment such as topical steroid treatment. We describe a case of dermatophyte infection with changes in clinical feature related to antifungal treatment. A 23-year-old woman presented with reddish annular scaly lesions on her right forearm. On the basis of the detection of hyphae on KOH examination, oral terbinafine 250 mg/day in combination with topical isoconazole was used for 3 weeks, but scattered papulopustules on erythematous bases occurred. Histopathologic examination revealed the presence of hyphae within the follicular infundibulum. Oral itraconazole 100 mg/day was administered for 2 weeks in combination with topical flutrimazole and produced a good clinical response. At her visit about 7 weeks after stopping itraconazole, agminated papulopustules on erythematous bases were seen on her right forearm. Trichophyton mentagrophytes was isolated on the culture of skin scraping from the surface of agminated lesions. She was successfully treated with oral fluconazole 150 mg weekly for 6 weeks and topical flutrimazole and isoconazole.
Arthrodermataceae ; Clotrimazole ; Diagnosis, Oral ; Female ; Fluconazole ; Forearm ; Humans ; Hyphae ; Itraconazole ; Miconazole ; Naphthalenes ; Skin ; Tinea ; Trichophyton ; Young Adult

The development of selective and safe antifungal agents are relatively delayed, compared to that of other antibiotics. The reasons are the relatively lesser interest of pharmaceutical companies because of the fewer occurrence of fungal disease and the apparent lack of a highly selective fungal target, not present in other eukaryotic (including mammalian) cells. Until the 1940s, fungal skin infection was treated by keratinolytics, antiseptics, and antibacterial chemicals. The first selective antifungal agent was polylene compounds in the early 1950s, which were topical nystatin and fungizone (amphotericin-B). In 1958, the first oral fungal agents, 'griseofulvin', as developed and have been used effectively to tinea capitis and other dermatophytes. Between the late 1960s and early 1970s, the azole compound, 'the real broad spectrum antifungal agents' was introduced, and clotrimazole was the first topical azole compound followed, by miconazole and econazole. Ketoconazole was released in early 1980s and it was the first real oral antifungal agent for systemic and superficial fungal infections. However, because of serious side effects of symptomatic hepatic injury, its use was replaced by triazole antifungal agents such as itraconazole and fluconazole. Triazole was more safe and effective, and caused advancement in the treatment of onychomycosis. In addition, terbinafine 'belonging to the allylamine compounds and developed in 1984', has been approved as a very potent antifungal agent for dermatophytes and also is being used widely to cutaneous infection by candidia species and some molds.
Allylamine ; Amphotericin B ; Anti-Bacterial Agents ; Anti-Infective Agents, Local ; Antifungal Agents* ; Arthrodermataceae ; Clotrimazole ; Danazol ; Dermatomycoses* ; Econazole ; Fluconazole ; Fungi ; Itraconazole ; Ketoconazole ; Miconazole ; Nystatin ; Onychomycosis ; Skin ; Tinea Capitis

BACKGROUND: The epidemiology of Candida species isolated from nonsterile as well as normally sterile sites is important because colonization of the former may precede invasive Candida infections. METHODS: We investigated the epidemiology and antifungal susceptibility of Candida species recovered in Busan Paik Hospital during the past 6 years and compared these results according to the type of specimens. RESULTS: Among the 2364 strains, C. albicans (53.8%) was the most frequently isolated, followed by C. tropicalis (17.5%), and C. guilliermondii (10.0%). Non-albicans Candida species were more prevalent in normally sterile sites (P<0.001); the prevalence of C. tropicalis and C. parapsilosis was significantly higher in normally sterile than in nonsterile sites (P<0.001). The prevalence of C. parapsilosis was higher in blood, intravenous catheter tips, and ear discharge, whereas C. tropicalis was more frequently isolated from urine. C. guilliermondii was the most frequently isolated from bronchial washings. The susceptibilities of Candida species to 5-flucytosine, amphotericin B, nystatin, miconazole, econazole, and ketoconazole were 98.3, 99.3, 99.7, 94.9, 86.3, and 94.5%, respectively. The susceptibilities of the organisms from normally sterile sites were lower than those from nonsterile sites. CONCLUSION: The distribution of Candida species differed among various types of specimens, especially those from normally sterile versus nonsterile sites. We assume that the frequency of infections of exogenous origin is high. We presume that the candidemia of C. parapsilosis is associated with the use of central venous catheter and that C. parapsilosis is acquired from exogenous sources.
Amphotericin B ; Busan ; Candida* ; Candidemia ; Catheters ; Central Venous Catheters ; Colon ; Ear ; Econazole ; Epidemiology ; Ketoconazole ; Miconazole ; Nystatin ; Prevalence

BACKGROUND: The frequency of nosocomial bloodstream infections by Candida species has risen dramatically in the past two decades, and a noticeable shift in the species of Candida causing bloodstream infection toward non-albicans species has occurred. Also, the isolation frequency of Candida species are influenced by patient type, nation and region, study period, and investigators. The aim of this study is to investigate the isolation rates and antifungal susceptibility of Candida species isolated from blood cultures at Wonju Christian Hospital during the recent four years (1997~2000). METHODS: For one-hundred twenty-seven isolates of Candida species from blood cultures, we analyzed the isolation frequency by year, age/sex, and department. Identification of yeasts was done by germ tube test and ATB ID 32 C kit. Antifungal susceptibilities to flucytosine, amphotericin B, nystatin, miconazole, econazole, and ketoconazole were determined by ATB FUNGUS. RESULTS: The isolation rates of Candida species in decreasing order were C. albicans (44.9%), C. parapsilosis (21.3%), C. glabrata (14.2%), and C. tropicalis (9.5%). The isolation rates of Candida species by year were as follows; C. albicans decreased from 61.5% in 1997 to 33.3% in 2000; C. tropicalis decreased from 23.1% in 1997 to 5.0% in 2000; C. parapsilosis increased from 0% in 1997 to 30.8% in 2000; and C. glabrata increased from 7.7% in 1997 to 18.0% in 2000. Of 127 Candida species, all but one isolates were susceptible to amphotericin B. CONCLUSION: This data showed that the candidemia by C. albicans and C. tropicalis are decreasing trend, and candidemia by C. parapsilosis and C. glabrata are increasing trend in recent four years.
Amphotericin B ; Candida* ; Candidemia ; Econazole ; Flucytosine ; Fungi ; Gangwon-do ; Humans ; Ketoconazole ; Miconazole ; Nystatin ; Research Personnel ; Yeasts

This study was performed for the standardization and proper selection of effective antifungal agents by measuring the minimal inhibitory concentra-tions[MICs]of antifungals to fungi, separated from keratitis patients.Two strains of A.fumigatus and single strain of F.solani, A.falciforme, and A . alternata were used for this test.Standard powders of miconazole, itraconazole, clotrimazole, ketoconazole, and amphotericin B were used as antifungal agents. Microscopic and macroscopic measurements of MIC after 24, 48 and 72 hours of inoculation[105 conidia /ml]into YNB broth with culture temperature of 25 degrees C were performed by use of broth microdilution method.The results are as follows : itraconazole, amphotericin B, and clotrimazole were effective against A.fumigatus.F.solani showed resistance to all kinds of antifungal agents.A.falciforme and A.alternata were sensitive to amphotericin B and itraconazole, respectively. Further studies may be needed for the standardized measurement of MIC against filamentous fungi and also for in Vitro-in Vivo correlations for the treatment of fungal keratitis.
Amphotericin B ; Antifungal Agents* ; Clotrimazole ; Fungi ; Itraconazole ; Keratitis* ; Ketoconazole ; Miconazole ; Powders ; Spores, Fungal

BACKGROUND: We thought that nitroimidazoles including metronidazole had been overused empirically for treatment of trichomoniasis in Korea. But there were not any reports about in vitro-drug susceptibility and distribution of resistant strains of Trichomonas vaginalis up to date. Therefore, we made an experiment in order to observe the susceptibility of clinical isolates of T. vaginalis to a variety of antiprotozoal agents. METHODS: Twenty-six strains of T. vaginalis isolated from 217 patients afflicted with the increased vaginal discharge were tested by Meingassner's microtiter plate method in newly devised anaerobic box, in which anaerobic and microaerobic conditions were more easily manipulated. The agents used in this study for testing the minimal lethal concentration (MLC) to the clinical isolates were as follows; nitroimidazoles, doxycycline, Zinc sulfate and gentian violet as chemotherapeutic agents and povidone-iodine as vaginal cleansing agents were studied. RESULTS: In anaerobic culture, according to anaerobic resistance cut-point (minimal lethal concentration >3.1 microgram/mL) proposed by M ller etc., metronidazole (MTZ)-, tinidazole (TNZ)-and ornidazole (ONZ)-resistant strains were four (4/26, 15.4%), two (2/26, 7.7 %) and two (2/26, 7.7%) strains, respectively. Among these resistant strains, two strains (G7 and G16) were resistant to two drugs and one strain (G20) resistant to three drugs concomitantly. Their resistance range was narrow as 6.25~12.5 microgram/mL. MLC of clotrimazole was > or = 2,000 microgram/mL in all strains, econazole was as high as 62.5~250 microgram/mL and miconazole was also high as 62.5~> or = 2,000 microgram/mL. In microaerobic culture (O2 concentration <5%), all strains showed lower MLC to MTZ, TNZ and ONZ than >100 microgram/ mL (aerobic resistance cut-point proposed by M ller etc.). MLC of doxycycline ranged 62.5 to 250 microgram/mL both in microaerobic and anaerobic conditions. All strains of T. vaginalis growed well in 3,000 microgram/mL of povidone-iodine. 22 strains (84.6%) among 26 T. vaginalis strains showed MLCs of 3.5 mM~7.0 mM to zinc sulfate. Gentian violet showed 15.6~62.5 microgram/mL of MLC. CONCLUSION: In absolute anaerobic culture, 4 strains (15.4%) among 26 T. vaginalis strains were resistant to metronidazole. But these 4 strains were not resistant in microaerobic culture depending on Miler's aerobic resistance cut-point (>50~100 microgram/mL), the value decided in normal O2 pressure. Vaginal PO2 is 0~28mm Hg (median 1 mmHg) at healthy or trichomonas-infected women. Therefore, we think that his aerobic resistance cut-point value is hard to be available in microaerobic condition and microaerobic resistance guide-line is to be established newly.
Anti-Infective Agents ; Antiprotozoal Agents* ; Clotrimazole ; Detergents ; Doxycycline ; Econazole ; Female ; Gentian Violet ; Humans ; Korea ; Metronidazole ; Miconazole ; Nitroimidazoles ; Ornidazole ; Povidone-Iodine ; Tinidazole ; Trichomonas vaginalis* ; Trichomonas* ; Vaginal Discharge ; Zinc Sulfate