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Intravaginal Boric Acid Cures 70% of C. glabrata.

DURBAN, SOUTH AFRICA -- Physicians seeking reliably effective therapy for Candida glabrata vaginitis must dust off a treatment that was in its heyday in the Crimean War era, Dr. Jack D. Sobel said at a satellite conference held in conjunction with WONCA 2001, the conference of the World Organization of Family Doctors.

Treatment with intravaginal boric acid gelatin capsules may have a 19th-century ring to it, but it also has a 70% cure rate in C. glabrata vaginitis--and that's a lot better than can be achieved with modern azole therapy "Candida glabrata is the Achilles' heel of azole therapy. None of the azoles do well with Candida glabrata," observed Dr. Sobel, professor of medicine at Wayne State University, Detroit.

The success rate with azole therapy in C. glabrata vaginitis is so spotty--producing cures in 50% of treated patients or less--that these agents are best skipped in women for whom an azole has previously failed.

Instead, turn to 600-mg boric acid capsules inserted into the vagina once or twice daily for 14 days, Dr. Sobel advised at the satellite conference sponsored by Pfizer Inc.

If boric acid fails, the drug of choice is topical 4% flucytosine once daily for 14 days. The cure rate with this treatment is greater than 90%.

An azole isn't unreasonable first-line therapy in patients who haven't previously failed on a drug ftom this class. But the single-dose or short-course azole regimens now favored for uncomplicated C. albicans vaginitis won't suffice when C. glabrata is the pathogen. This infection warrants at least 1 week of a topical azole or three tablets of fluconazole every third day.
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Title Annotation:Candida
Author:JANCIN, BRUCE
Publication:Internal Medicine News
Date:Sep 15, 2001
Words:268
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