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.

KEYWORDS:

• Azole resistance vulvovaginal candidiasis
• fluconazole resistant vaginitis refractory candida vulvovaginitis
• recurrent candida vulvovaginitis

Article highlights

• Vaginitis caused by azole-resistant non-albicans Candida species is well known as a severe limiting factor in success of available treatment regimens.

• Recently refractory vaginitis caused by C.albicans resistant to available azole agents has increased in frequency.

• Azole-resistant vaginitis constitutes a major challenge to successful treatment given paucity of alternative systemic and local agents.

• Pathogenesis of acquired fluconazole resistance is a consequence of frequent and prolonged fluconazole exposure.

• In vitro studies of fluconazole resistance in C.albicans is predominantly the result of enhancing efflux pumps which drive the active drug out of the fungal cell.

• Rescue regimens are somewhat infrequent and require in vitro susceptibility testing.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.