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Cited by 127Antifungal resistance and susceptibilityReproductive tract infections researchUrinary Tract Infections Management

Individualized decreasing-dose maintenance fluconazole regimen for recurrent vulvovaginal candidiasis (ReCiDiF trial)

Donders, Gilbert, Bellen, Gert, Byttebier, Geert, Verguts, Luc, Hinoul, Piet, Walckiers, Ronald, Stalpaert, Michel, Vereecken, Annie +1 more·2008·American Journal of Obstetrics and Gynecology
DOI 10.1016/j.ajog.2008.06.029
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Abstract

Objective Although many women with recurrent vulvovaginal candidiasis initially benefit from prophylactic intermittent treatment with antimycotics, most of them experience relapse after cessation of therapy, and often they return to the pretreatment recurrence rate. The purpose of this study was to demonstrate the efficacy and safety of an individualized, degressive, prophylactic regimen in 136 women with recurrent vulvovaginal candidiasis.Study design After an induction dose of 600 mg fluconazole during the first week, 117 women started maintenance therapy: 200 mg fluconazole weekly for 2 months, followed by 200 mg biweekly for 4 months, and 200 mg monthly for 6 months, according to their individual response to therapy. All women were tested for recurrences monthly with wet mount microscopy and vaginal culture during the first 6 months and bimonthly during the next 6 months. Patients were allowed to move on to the next level of maintenance therapy only if they were symptom free and microscopy and culture negative.Results Of the women who were cured successfully after the induction phase, 101 women (90%) were disease-free after 6 months of maintenance therapy with this degressive regimen, and 80 women (77%) were disease-free after 1 year. The weekly incidence of the first clinical relapse was 0.5% during any period of the maintenance phase, and the rate of all new relapses, which included evidence of mycologic or microscopic colonization, was 1% per week. Women who experienced several relapses (poor responders) had experienced more relapses before entering the study compared with the optimal responders (odds ratio, 4.9; 95% CI,1.8-13.7; P = .002), experienced the disease for a longer period of time (6.5 vs 3.7 years; P = .06), and harbored significantly more Candida non-albicans during maintenance therapy (P = .001). No serious side-effects were noted.Conclusion Individualized, degressive, prophylactic maintenance therapy with oral fluconazole is an efficient treatment regimen to prevent clinical relapses in women with recurrent vulvovaginal candidiasis.

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Crossref · 10.1016/j.ajog.2008.06.029

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  • Although symptom resolution is achieved in ~90% of women with RVVC who undergo at least 6 months of maintenance therapy, up to 50% will have a recurrence after the termination of maintenance therapy.

    “Although symptom resolution is achieved in ~90% of women with RVVC who undergo ⩾6 months of maintenance therapy,16,21,22 up to 50% will have a recurrence after the termination of maintenance therapy. 13”

    From Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis (2022) · cites this paper as [22]

  • An alternative maintenance regimen of 200 mg doses of fluconazole weekly for 2 months, then every 2 weeks for 4 months, followed by once-monthly 200 mg doses for another 6 months has also been assessed.

    “An alternative maintenance regimen of 200 mg doses of fluconazole weekly for 2 months, then every 2 weeks for 4 months, followed by once-monthly 200 mg doses for another 6 months has also been assessed.22,23”

    From Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis (2022) · cites this paper as [22]

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Authors
Donders, G., Bellen, G., Byttebier, G., Verguts, L., Hinoul, P., Walckiers, R., Stalpaert, M., Vereecken, A., & Van Eldere, J.
Affiliations
  • Universitair Ziekenhuis Leuven (BE)
  • Ziekenhuis Oost-Limburg (BE)
Corresponding author
Donders, Gilbert
ORCID
Venue
American Journal of Obstetrics and Gynecology
Publisher
Elsevier BV
Published
2008-12
Volume
199
Issue
6
Pages
613.e1-613.e9
ISSN
0002-9378 (ISSN-L)
DOI
10.1016/j.ajog.2008.06.029
OpenAlex
W2099216984
Cited by
127
References
14
Citations by year
2026: 2 · 2025: 7 · 2024: 9 · 2023: 8 · 2022: 9 · 2021: 8 · 2020: 8 · 2019: 4 · 2018: 9 · 2017: 12 · 2016: 7 · 2015: 10 · 2014: 7 · 2013: 7 · 2012: 5
FWCI
3.20
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • American Journal of Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
  • Health Sciences › Medicine › Epidemiology › Urinary Tract Infections Management
Keywords
recurrent vulvovaginal candidiasis, fluconazole, maintenance therapy, prophylaxis, individualized dosing, relapse prevention, non-albicans Candida, treatment response
MeSH terms
Administration, Oral, Adolescent, Adult, Antifungal Agents, Candidiasis, Vulvovaginal, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Follow-Up Studies, Humans, Middle Aged, Probability, Prospective Studies, Severity of Illness Index, Time Factors, Fluconazole, Treatment Outcome, Patient Satisfaction, Risk Assessment, Kaplan-Meier Estimate, Secondary Prevention, Young Adult

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