Vulvovaginal candidiasis (VVC) is one of the most common diseases, affecting up to 75% of women of childbearing age. Many questions of its etiology and pathogenesis, including the development and formation of chronic and complicated forms, remain controversial and not fully resolved.
The widespread use of EBC is associated with the effect of various environmental factors on the woman’s body, a change in the ecological situation, the widespread use of antibiotics and their interaction, which leads to a decrease in the body’s immunological defense. Other predisposing factors are also important, such as radiation therapy, long-term use of oral contraceptives, corticosteroids and cytostatics, metabolic and endocrine system disorders, chronic diseases of the gastrointestinal tract, hypo- and avitaminosis, immunodeficiencies that developed against the background of an infectious or hematological disease , oncological process, intoxication, etc.
KVV – payment for civilization. Its development is facilitated by wearing underwear made of synthetic fabrics that tightly fit the body, when a microclimate with high humidity and temperature is created, leading to maceration of the stratum corneum and creating favorable conditions for the development of local microflora, including intestinal microflora. In this microflora among the fungi of the genus Candida, the most common causative agent of CVC C. albicans is over 95%.
Fungi of the genus Candida are conditionally pathogenic microorganisms and can be isolated from the vagina of a practically healthy woman. But when exposed to aggravating factors, they acquire pathogenic properties and become the cause of CVI. Usually, VVC occurs endogenously as a consequence of dysmetabolic disorders and dysfunction of the immune system, but infection is also possible through sexual contact, although this point of view is still controversial and the sexual route of transmission is currently not considered significant.
There are uncomplicated and complicated forms of CVI. Antifungal susceptible C. albicans is the main cause of nearly 90% of uncomplicated mild to moderate EBC cases. In complicated forms of CVI, the disease acquires a severe course with frequent recurrence (more than 4 times a year) and is observed, as a rule, in women with extragenital pathology. The main causative agent of complicated CVI is Candida spp., Not belonging to the C. albicans species.
The ubiquitous number of patients with VVC dictates the need for timely diagnosis and rational etiotropic therapy.
The drugs used in the treatment of VKK are intended for both local and / or systemic use.
Systemic antifungal therapy is prescribed in the case of a pronounced clinical picture of IHC, chronic course of the disease, resistance to local therapy, and immunodeficiency (HIV infection). The most effective drugs of systemic action are azole compounds: fluconazole and itraconazole.
In the case of an uncomplicated course of IHC, drugs of local action are used for 6-7 days or drugs of systemic action (fluconazole 150 mg once, itraconazole 200 mg 2 times a day for 3 days).
In cases of a complicated course of VVC, the course of therapy should be doubled, while the duration of the use of local drugs should be 14 days. Systemic antimycotics (fluconazole, itraconazole) in all cases of chronic recurrent VVC are recommended as the main course of therapy.
In recent years, there has been a decrease in the sensitivity of opportunistic microorganisms to antibiotics. In this regard, new, pathogenetically grounded methods of treatment of VKK and mixed bacterial-fungal infections of the vagina are being developed, including with the local use of antiseptics. Gynecologists and their patients have at their disposal a large number of antifungal drugs and antiseptics, suitable or specially designed for the treatment of VVC (both as prescribed by a doctor and without a prescription). While self-medication with systemic antimycotics is becoming more and more popular, local therapy remains the most demanded and safest method of treatment. Specially conducted studies have shown that specialized intravaginal forms of antimycotics are currently most in demand, occupying more than half of the methods used for self-treatment and more than a quarter in treatment according to the doctor’s prescriptions in monotherapy.
Currently available topical antifungal agents include vaginal suppositories / balls or tablets, and special vaginal creams. The choice of a drug in each specific case should depend on the severity of the clinical course of VKK, the presence of mixed infection, concomitant pathology, and predisposing factors. The active ingredients generally include imidazole or polyene antimycotics. The latter include various preparations of nystatin and natamycin. Among the imidazoles, clotrimazole preparations are most commonly used. In addition, there are vaginal forms of miconazole, econazole, isoconazole, omokonazole and other imidazole derivatives.
Despite the variety of existing methods of treatment of vulvar and vaginal candidiasis, their frequency does not tend to decrease. This circumstance encourages practitioners to constantly search for and test new medications
offered by the pharmaceutical market for the treatment of this pathology.
Since the highly active antifungal imidazoles were introduced for the treatment of vulvovaginal candidiasis about 20 years ago, two important developments have occurred: one has expanded our knowledge of the pathogenesis of the disease, and the other has changed our view of the required duration of effective treatment.
Imidazoles remain the first-line treatment for vulvovaginal candidiasis. However, it is recognized that up to 50% of patients stop treatment after experiencing relief of symptoms. To improve adherence, physicians developed a trend to shorten drug use times, and as a result, treatments with miconazole nitrate and clotrimazole were shortened from the initial 14 days to 7 and 3. Ultimately, a single dose regimen was developed. , thanks to the creation of a new bioadhesive matrix in the form of a prolonged-release cream for intravaginal use with 2% butoconazole nitrate (butoconazole 1-BSR). Butoconazole nitrate was selected for its very acceptable safety profile and proven clinical efficacy. Meticulous analyzes have shown its broad spectrum of antifungal activity: it has consistently shown high activity against the most important eight non-albicans Candida species. Butoconazole 1-BSR outperformed the currently used imidazoles (miconazole, clotrimazole, ketoconazole, and terconazole) in inhibiting the growth of C. albicans and for pathogenic Candida species other than albicans.
Effective therapies using a single dose of potent fungicidal imidazoles seem to be nearly ideal for the clinical suppression of vaginal mycoses.
For the doctor, they actually guarantee the patient’s full compliance with the treatment regimen. Single dose therapy minimizes the inconvenience of long-term therapy plans. Repeated doses of the drug are especially unpleasant for the physically active or frequent traveler. Additional inconveniences are drug leakage and possible restriction of sexual activity during repeated doses of the drug.
In this regard, a vaginal cream with butoconazole 1-BSR (in 2% concentration) is of particular interest, which has the ability to adhere to the surface of the vaginal mucosa for a long period of time with a continuous release of the active substance, which ensures constant contact of the active active substance with the pathogenic agent and as a result, its high antifungal activity. The cream does not leak out of the vagina or cause irritation. Clinical studies and experience confirm that this cream lasts twice as long in the vagina as a conventional vaginal cream, and its systemic absorption is three times lower. A single intravaginal dose of butoconazole (2%) in a prolonged-release cream provides a speed of healing comparable to the speed of the known seven-day regimen of therapy with daily doses of miconazole nitrate (2%) in a regular vaginal cream. An additional advantage of butoconazole 1-BSR is the significantly faster relief of severe symptoms of vulvovaginal candidiasis, which is already detected on the first day after administration of the drug.
Butoconazole is an antifungal imidazole proven to be effective in the treatment of VKK. The guaranteed patient compliance with the single application of the drug, its efficacy and very favorable safety profile support its use in the treatment of VKK in clinical practice.