MANAGING RECURRENT VULVO-VAGINAL CANDIDIASIS - INTERMITTENT PREVENTION WITH ITRACONAZOLE

OBJECTIVE: To evaluate the efficacy of one-day, intermittent, monthly prophylaxis with 400 mg itraconazole in the management of recurrent vu lvovaginal candidiasis. STUDY DESIGN: In a randomized trial, 57 patien ts and 57 controls with recurrent vulvovaginal candidiasis were assign ed either to receive one-day monthly itraconazole prophylaxis for six months or no treatment. Clinical and mycologic evaluations were carrie d out 3, 6 and 12 months after enrollment. RESULTS: During the first s ix months of follow-up, the rate of symptomatic recurrences was 36.4% (20/55) among the treated women and 64.2% (34/53) in the controls. The mean time +/- SEM to symptomatic recurrence was 149 +/- 6 days among patients receiving prophylaxis and 120 +/- 8 days in the controls (P = .003 by log-rank test). These differences disappeared almost complete ly after the cessation of intermittent prophylaxis. In fact, the propo rtion of patients still asymptomatic after one year of follow-up was 3 8.9 % (21/54) among treated women and 28.8% (15/53) in the controls (P = .83 by Fisher's exact test). CONCLUSION: One-day monthly, intermitt ent itraconazole prophylaxis reduced the rate of recurrence in patient s with recurrent vulvovaginal candidiasis, but the beneficial effect o f itraconazole was lost within a few months after cessation of prophyl axis.