LONGITUDINAL INVESTIGATION OF CANDIDA-VAGINITIS IN PREGNANCY - ROLE OF SUPERIMPOSED ANTIBIOTIC USE

Objective: To evaluate the purported association of antibiotic use and subsequent symptomatic Candida vaginitis among pregnant women. Method s: Two hundred fifty obstetric patients were followed in a prospective , culture-based, longitudinal, and observational study from the first antepartum appointment through the postpartum visit at 6 weeks. All pa tients were cultured for yeast (Nickerson agar) initially. Patients wi th symptoms and microscopic evidence of vaginitis at the initial visit were followed through pregnancy but were not analyzed with asymptomat ic individuals who had vaginal cultures for Candida at the first visit and at subsequent visits if they developed vulvovaginal symptoms. Pat ients were categorized as colonized or uncolonized on the basis of ini tial cultures and were evaluated at least monthly for antibiotic use a nd vaginal complaints. In addition, hospital records were reviewed aft er the final visit to document antibiotic use or vaginal infection. Re sults: Asymptomatically colonized patients were at a threefold greater risk of developing symptoms than were uncolonized patients (P < .001) . Among women receiving antibiotics during pregnancy, 6.1% developed s ymptoms of Candida vaginitis compared with 15.6% of women who did not receive antibiotics. For the entire study population, 46% of the patie nts received at least one course of antibiotic therapy and 21% had mul tiple courses. Only three of the seven who became symptomatic with yea st vaginitis did so within 4 weeks of treatment. Many of the antibioti c regimens were prescribed by providers other than the obstetrician. C onclusion: Antibiotic treatment during pregnancy was frequent in the s tudy population, but was not associated with a significant risk of dev eloping Candida vaginitis.