Antifugal susceptibility testing in chronically recurrent vaginal candidosis as basic for effective therapy

The chronically recidivist vulvo-vaginal candidiasis is one of the most stu bborn problematic diagnosis in the dermatology and gynaecology ward. Progno sis and therapy are primarily determined by the causative micro-organism an d the interaction of the fungal species with the currently available antifu ngal agents. Objective of the study was the investigation of vaginal yeast isolates from patients with chronically recidivist vaginal candidiasis agai nst 8 antifungal agents with the aim of optimising the standard therapy wit h azole antifungal agents and assessment of alternative therapy schemes. 55 clinical isolates (Dermatology, Charite) of 40 patients were tested by mic rodilution according to DIN 58940-84. Species differentiation and identific ation was performed by Fourier-Transform Infrared Spectroscopy (FTIR). In t he result Candida glabrata was the predominant causative agent for the reci divist vaginal candidiasis. MIC-mode values for C. glabrata were: fluconaco le 32 mug/ml, intraconacole 1 mug/ml, ketoconacole 1 mug/ml, amphotericine B, voriconacole 0,03 mug/ml, amphotericin B 0,5 mug/ml, terbinafine 128 mug /ml, cicloproxolamie 4 mug/ml, 5-fluorocytosine 0,03 mug/ml. Some strains o f Patients with suboptimal introductory low doses of fluconacole showed inc reasing of MIC in course of therapy. Parallel resistance with intraconacole was observed in all theese cases. Consecutively isolated strains could be clearly and reliably identified by FTIR. In conclusion of most importance i s the initial doses adaptation of the drug used, e.g. for fluconacole 800/d p.o., when C. glabrata is the causative agent. Low dose fluconacole therap y is always unsuccessful in recurrent vaginal candidiasis and induces secon dary resistance. Demonstrated high susceptibility of voriconacole, amphoter icine B an 5-fluorocytosine particularly for C. glabrata may indicate of an anitmycotic therapy potential unconsidered regarding to dermatological ind ication up to now.