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Current treatment options for vulvovaginal candidiasis caused by azole-resistant Candida species
Abstract
INTRODUCTION: Clinicians are increasingly challenged by patients with refractory vulvovaginal candidiasis (VVC) caused by azole-resistant Candida species. Fluconazole resistant C.albicans is a growing and perplexing problem following years of indiscriminate drug prescription and unnecessary drug exposure and for which there are few therapeutic alternatives. Regrettably, although the azole class of drugs has expanded, new classes of antifungal drugs have not been forthcoming, limiting effective treatment options in patients with azole resistant Candida vaginitis. AREAS COVERED: This review covers published data on epidemiology, pathophysiology and treatment options for women with azole-resistant refractory VVC. EXPERT OPINION: Fluconazole resistant C.albicans adds to the challenge of azole resistant non-albicans Candida spp. Both issues follow years of indiscriminate drug prescription and unnecessary fluconazole exposure. Although an understanding of azole resistance in yeast has been established, this knowledge has not translated into useful therapeutic advantage. Treatment options for such women with refractory symptoms are extremely limited. New therapeutic options and strategies are urgently needed to meet this challenge of azole drug resistance.
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In the citing paper
“Recurrence can also result from developed resistance to antifungal treatment, usually due to prolonged or repeated use of a single agent. 11”
From Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis (2022) · cites this paper as [11]
In the citing paper
“Although breakthrough infections are still relatively rare (usually < 5% of patients), in vitro susceptibility testing can be useful in selecting subsequent treatment.11,18”
From Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis (2022) · cites this paper as [11]
In the citing paper
“Development of azole-resistant infection may be suspected in women who do not respond to standard treatment regimens or who experience breakthrough symptoms despite compliant long-term fluconazole maintenance therapy. 11”
From Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis (2022) · cites this paper as [11]
In the citing paper
“Treating azole-resistant vaginitis constitutes a major clinical challenge for providers, given the current paucity of alternative antimycotic agents. 11”
From Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis (2022) · cites this paper as [11]
In the citing paper
“in vitro susceptibility testing can be useful in selecting subsequent treatment.11,18”
From Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis (2022) · cites this paper as [11]
In the citing paper
“In addition, non-albicans Candida species are frequently dose-dependent susceptible or resistant to fluconazole and other azoles, and their prevalence is rising.”
From Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion (2022) · cites this paper as Sobel and Sobel, 2018
In the citing paper
“A long-term prophylactic maintenance regimen with antifungals is often necessary.”
From Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion (2022) · cites this paper as Sobel and Sobel, 2018
In the citing paper
“Available therapeutic options to treat such fluconazole-resistant C. albicans and low susceptibility non-albicans strains are limited.”
From Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion (2022) · cites this paper as Sobel and Sobel, 2018
In the citing paper
“Many fluconazole-resistant C. albicans strains are also cross-resistant to other azole drugs available for treating VVC.”
From Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion (2022) · cites this paper as Sobel and Sobel, 2018
In the citing paper
“Fluconazole-resistant C. albicans vaginitis usually represents less than 5% of isolates obtained from women with RVVC (Sobel and Sobel, 2018; Collins et al., 2020).”
From Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion (2022) · cites this paper as Sobel and Sobel, 2018
In the citing paper
“Treatment with first- or second-generation azoles for C glabrata infection is usually unsuccessful, and local nystatin, ciclopiroxolamine, or boric acid is recommended (Sobel and Sobel, 2018).”
From Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion (2022) · cites this paper as Sobel and Sobel, 2018
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Self-citation
Metadata
- Authors
- Sobel, J. D., & Sobel, R.
- Affiliations
- Wayne State University (US)
- Thomas Jefferson University Hospital (US)
- Corresponding author
- Sobel, J. D.
- Venue
- Expert Opinion on Pharmacotherapy
- Publisher
- Informa UK Limited
- Published
- 2018-06-13
- Volume
- 19
- Issue
- 9
- Pages
- 971-977
- ISSN
- 1465-6566 (ISSN-L)
- 1744-7666
- OpenAlex
- W2809133082
- Cited by
- 168
- References
- 56
- Citations by year
- 2026: 11 · 2025: 19 · 2024: 24 · 2023: 39 · 2022: 34 · 2021: 20 · 2020: 13 · 2019: 7 · 2018: 1
- FWCI
- 1.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Expert Opinion on Pharmacotherapy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- not funded
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Life Sciences › Agricultural and Biological Sciences › Plant Science › Fungal Plant Pathogen Control
- Keywords
- vaginal candidiasis, azole resistance, Candida albicans, fluconazole resistance, non-albicans Candida, antifungal resistance, Candida vaginitis
- MeSH terms
- Antifungal Agents, Boric Acids, Candida, Candidiasis, Vulvovaginal, Female, Humans, Microbial Sensitivity Tests, Fluconazole, Drug Resistance, Fungal, 14-alpha Demethylase Inhibitors
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