Akinosoglou Karolina, Livieratos Achilleas, Asimos Konstantinos, Donders Francesca, Donders Gilbert G G
Department of Medicine, University of Patras, 265 04 Rio, Greece.
Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 265 04 Rio, Greece.
Pharmaceutics. 2024 Dec 4;16(12):1555. doi: 10.3390/pharmaceutics16121555.
Currently, the rising prevalence of resistant species, particularly , as well as non-albicans isolates such as and , represent challenges in their management. In this review, we aimed to explore the current management of fluconazole-resistant vulvovaginal candidiasis (FRVVC). Identified studies focused on alternative antifungal therapies, including boric acid, nystatin, and newer agents like oteseconazole and ibrexafungerp. The findings highlight the need for tailored treatment regimens, considering the variability in resistance patterns across regions. Unprofessional as well as professional overuse of antifungals for vulvovaginal symptoms that are not caused by infections should be combatted and banned as much as possible. Instead of high-dose maintenance regimens using weekly doses of 150 to 200 mg of fluconazole for 6 months or longer, it is advisable to use an individualised degressive regimen (ReCiDiF regimen) in order to tailor the treatment of a particular patient to the lowest dosage possible to keep the diseases controlled. Additionally, this report underscores the impact of antibiotic use on the microbiota, which can raise the possibility of VVC and lead to fluconazole resistance, emphasizing the necessity for cautious antibiotic prescribing practices.
目前，耐药菌株的流行率不断上升，尤其是 ，以及非白色念珠菌分离株，如 和 ，给它们的管理带来了挑战。在本综述中，我们旨在探讨目前对氟康唑耐药性外阴阴道念珠菌病（FRVVC）的管理。已确定的研究集中在替代抗真菌疗法，包括硼酸、制霉菌素，以及奥替康唑和艾伯康唑等新型药物。研究结果强调了制定个性化治疗方案的必要性，要考虑到不同地区耐药模式的差异。对于并非由 感染引起的外阴阴道症状，无论是非专业人员还是专业人员过度使用抗真菌药物的情况都应予以抵制并尽可能禁止。不应采用每周服用150至200毫克氟康唑、持续6个月或更长时间的高剂量维持治疗方案，建议采用个体化递减治疗方案（ReCiDiF方案），以便根据特定患者的情况将治疗调整到尽可能低的剂量，以控制病情。此外，本报告强调了抗生素使用对微生物群的影响，这可能增加患VVC的可能性并导致氟康唑耐药，强调了谨慎开具抗生素处方的必要性。
