BORIC ACID
Place in Therapy
Place in Therapy
Boric acid therapy is not recommended as a first line option for uncomplicated vulvovaginal candidiasis infections.4 When it comes to self-care selection of vaginal yeast infection products, boric acid would not be something that a patient would consider as it is not available commercially but needs to be compounded on special request.1,4 Boric acid is a schedule two drug and could be compounded based on the pharmacist’s discretion, however there are very specific instances when this would occur and it would not take place without collaboration from the patient’s primary health care provider.1,2,4 When a patient has experienced previous failure of first line azole therapy or there is a confirmed or suspected azole resistant Candida strains involved, then a pharmacist could recommend boric acid therapy as a potential option to the patient and their health care provider.2,3,4,8,9 In addition, if a patient has experienced past hypersensitivity to azole therapy then boric acid would also be a reasonable option to suggest as it is proven to be effective in both C. albican, C. glabrata, and azole resistant infections.2
C. glabrata is the most common non-C. albicans species found in vulvovaginal candidiasis infections and many strains are resistant to azole therapy, therefore when treating women who are highly susceptible to this type of infection such as diabetic women, boric acid therapy has proven to demonstrate a high mycological cure rate compared to other agents.3,5,6,8 Boric acid therapy should be recommended to physicians for women who are diagnosed with diabetes and frequently experience vulvovaginal candidiasis episodes.5 Boric acid does have a place in acute, recurrent, and chronic azole-resistant non-albicans Candida species infections and local adverse effects are uncommonly reported.2,3,6,8,9 The recommended course of therapy in all of the previously mentioned clinical scenarios is 600mg vagainal capsules/suppositories twice daily for 14 days.2,3,4,8,9 However, studies have shown that the long-term mycological cure rates are poor when using boric acid therapy for complicated cases and that often maintenance therapy is recommended as boric acid 600mg every other day then twice weekly for maintenance therapy.2,3,4,6,7 An alternative option for maintenance/preventative therapy that has been proven to be effective for women who are highly susceptible to vaginal yeast infections is the use of boric acid therapy during menstruation, here you would use 300mg capsule intravaginally for 5 days each month beginning the first day for the menstrual cycle.2,3,4,7
References:
1. Boric Acid. In: DRUGDEX® System [Internet database]. Greenwood Village, Colo: Thomson Reuters (Healthcare) Inc. Updated periodically. Retrieved on June 21, 2012 from: http://www.thomsonhc.com/micromedex2/librarian/ND_T/evidencexpert/ND_PR/evidencexpert/CS/0CD53E/ND_AppProduct/evidencexpert/DUPLICATIONSHIELDSYNC/1D45FD/ND_PG/evidencexpert/ND_B/evidencexpert/ND_P/evidencexpert/PFActionId/evidencexpert.IntermediateToDocumentLink?docId=1081&contentSetId=31&title=BORIC+ACID&servicesTitle=BORIC+ACID
2. Neves J, Pinto E, Teixeira B, Dias G, Rocha P, Cunha T, Santos B, Amaral M, and Bahia M. Local treatment of vulvovaginal candidosis: General and practical considerations. Drugs. 2008: 68 (13): 1787-1802.
3. Prutting SM, and Cerveny JD. Boric acid vaginal suppositories: A brief review. Infectious Disease in Obstetrics and Gynecology. 1998. 6: 191-194.
4. Public Health Agency of Canada. Vaginal discharge (bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis). Canadian Guidelines on Sexually Transmitted Inections. 2008. pp.1-14 .
5. Ray D, Goswami R, Banerjee U, Dadhwal V, Goswami D, Mandal P, Sreenivas V, and Kochupillai N. Prevalence of Candida glabrata and its response to boric acid vaginal suppositories in comparison with oral fluconazole in patients with diabetes and vulvovaginal candidiasis. Diabetes Care. 2007. 30: 312-317.
6. Ray D, Goswami R, Dadhwal V, Goswami D, Banerjee U, and Kochupillai N. Prolonged (3-month) mycological cure rate after boric acid suppositories in diabetic women with vulvovaginal candidiasis. Journal of Infection. 2007. 55: 374-377.
7. Ringdalh, E.N. Treatment of recurrent vulvovaginal candidiasis. American Family Physician. 2000. 61 (11): 3306-3314.
8. Sobel JD, and Chaim W. Treatment of Torulopsis glabrata Vaginitis: Retrospective review of boric acid therapy. Clinical Infectious Diseases. 1997; 24: 649-52.
9. Sobel JD, Chaim W, Nagappan V, and Leaman D. Treatment of vaginitis caused by Candiada glabrata: Use of topical boric acid and flucytosine. American Journal of Obstetrics and Gynecology. 2003; 189: 1297-300.
Boric acid therapy is not recommended as a first line option for uncomplicated vulvovaginal candidiasis infections.4 When it comes to self-care selection of vaginal yeast infection products, boric acid would not be something that a patient would consider as it is not available commercially but needs to be compounded on special request.1,4 Boric acid is a schedule two drug and could be compounded based on the pharmacist’s discretion, however there are very specific instances when this would occur and it would not take place without collaboration from the patient’s primary health care provider.1,2,4 When a patient has experienced previous failure of first line azole therapy or there is a confirmed or suspected azole resistant Candida strains involved, then a pharmacist could recommend boric acid therapy as a potential option to the patient and their health care provider.2,3,4,8,9 In addition, if a patient has experienced past hypersensitivity to azole therapy then boric acid would also be a reasonable option to suggest as it is proven to be effective in both C. albican, C. glabrata, and azole resistant infections.2
C. glabrata is the most common non-C. albicans species found in vulvovaginal candidiasis infections and many strains are resistant to azole therapy, therefore when treating women who are highly susceptible to this type of infection such as diabetic women, boric acid therapy has proven to demonstrate a high mycological cure rate compared to other agents.3,5,6,8 Boric acid therapy should be recommended to physicians for women who are diagnosed with diabetes and frequently experience vulvovaginal candidiasis episodes.5 Boric acid does have a place in acute, recurrent, and chronic azole-resistant non-albicans Candida species infections and local adverse effects are uncommonly reported.2,3,6,8,9 The recommended course of therapy in all of the previously mentioned clinical scenarios is 600mg vagainal capsules/suppositories twice daily for 14 days.2,3,4,8,9 However, studies have shown that the long-term mycological cure rates are poor when using boric acid therapy for complicated cases and that often maintenance therapy is recommended as boric acid 600mg every other day then twice weekly for maintenance therapy.2,3,4,6,7 An alternative option for maintenance/preventative therapy that has been proven to be effective for women who are highly susceptible to vaginal yeast infections is the use of boric acid therapy during menstruation, here you would use 300mg capsule intravaginally for 5 days each month beginning the first day for the menstrual cycle.2,3,4,7
References:
1. Boric Acid. In: DRUGDEX® System [Internet database]. Greenwood Village, Colo: Thomson Reuters (Healthcare) Inc. Updated periodically. Retrieved on June 21, 2012 from: http://www.thomsonhc.com/micromedex2/librarian/ND_T/evidencexpert/ND_PR/evidencexpert/CS/0CD53E/ND_AppProduct/evidencexpert/DUPLICATIONSHIELDSYNC/1D45FD/ND_PG/evidencexpert/ND_B/evidencexpert/ND_P/evidencexpert/PFActionId/evidencexpert.IntermediateToDocumentLink?docId=1081&contentSetId=31&title=BORIC+ACID&servicesTitle=BORIC+ACID
2. Neves J, Pinto E, Teixeira B, Dias G, Rocha P, Cunha T, Santos B, Amaral M, and Bahia M. Local treatment of vulvovaginal candidosis: General and practical considerations. Drugs. 2008: 68 (13): 1787-1802.
3. Prutting SM, and Cerveny JD. Boric acid vaginal suppositories: A brief review. Infectious Disease in Obstetrics and Gynecology. 1998. 6: 191-194.
4. Public Health Agency of Canada. Vaginal discharge (bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis). Canadian Guidelines on Sexually Transmitted Inections. 2008. pp.1-14 .
5. Ray D, Goswami R, Banerjee U, Dadhwal V, Goswami D, Mandal P, Sreenivas V, and Kochupillai N. Prevalence of Candida glabrata and its response to boric acid vaginal suppositories in comparison with oral fluconazole in patients with diabetes and vulvovaginal candidiasis. Diabetes Care. 2007. 30: 312-317.
6. Ray D, Goswami R, Dadhwal V, Goswami D, Banerjee U, and Kochupillai N. Prolonged (3-month) mycological cure rate after boric acid suppositories in diabetic women with vulvovaginal candidiasis. Journal of Infection. 2007. 55: 374-377.
7. Ringdalh, E.N. Treatment of recurrent vulvovaginal candidiasis. American Family Physician. 2000. 61 (11): 3306-3314.
8. Sobel JD, and Chaim W. Treatment of Torulopsis glabrata Vaginitis: Retrospective review of boric acid therapy. Clinical Infectious Diseases. 1997; 24: 649-52.
9. Sobel JD, Chaim W, Nagappan V, and Leaman D. Treatment of vaginitis caused by Candiada glabrata: Use of topical boric acid and flucytosine. American Journal of Obstetrics and Gynecology. 2003; 189: 1297-300.