The future of non-invasive azole antifungal treatment options for the management of vulvovaginal candidiasis

Abstract

Introduction: High worldwide prevalence and significant morbidity of vulvovaginal candidiasis (VVC) requires better therapeutic approaches to improve quality of life of affected women. Although treatment of acute episodes is often straightforward, complicated and recurrent vulvovaginal candidiasis (RVVC) presents medical challenges.

Area covered: This review focuses on therapy of VVC particularly by topical antifungals , especially imidazoles, compared to oral treatment with fluconazole, itraconazole, ibrexafungerp, or oteseconazole. Candidiasis by non-Candida albicans, VVC in pregnant women and RVVC are complex challenges . Current treatment, alternatives, and roles played by topical azoles in VVC are highlighted.

Expert opinion: VVC requires personalized treatment considering whether the woman is pregnant or not, concomitant treatments, clinical presentations (acute or recurrent) and the Candida species involved. Although therapeutic tools are increasing, the usefulness of topical drugs, such as clotrimazole and miconazole, is very relevant. In addition, we it is also necessary to expand the therapeutic tools with new antifungals and formulations, and repurposing current drugs against fluconazole-resistant species of Candida.

Keywords: Vulvovaginal candidiasis; clotrimazole; miconazole; non-invasive azoles; sertaconazole; terconazole; tioconazole; treatment.