CLOTRIMAZOLE
Place in Therapy
Place in Therapy
Clotrimazole should be considered as a first line agent in the treatment of uncomplicated vulvovaginal candidiasis in cases appropriate for self-care 1. Intra-vaginal treatment with clotrimazole has been shown to be equally effective to a single dose treatment of fluconazole 2, 3, 4. There are also no significant differences in effectiveness between single-dose and multiple-dose treatments with intra-vaginal antifungals such as clotrimazole 2. Although there were limitations to the primary literature reviewed, the results were comparable to the oral alternative 3, 4. Clotrimazole has known efficacy against C. albican 5. It also has a history of effective use for uncomplicated vulvovaginal candidiasis and is a first line recommendation by experts 1, 6.
Clotrimazole is safe in most populations, including women who are pregnant or breastfeeding, however it is not recommended during the first trimester of pregnancy 7. It is recommended that in pregnancy, a lower strength formulation should be used for a longer duration of time rather than the higher concentrations available (for example: 1% cream for 7 days). Since it is minimally absorbed systemically, there are no significant drug interactions 8. Clotrimazole should be avoided in patients who have had a previous hypersensitivity reaction to the formulation 8, 9. Clotrimazole should not be used as a first line agent in persistent cases or in women with additional complications 1 (please refer to red flags).
References:
1. Patient Self-Care. 1st Edition. Canadian Pharmacists Association 2002. Chapter 50 – Vaginal Symptoms. Laura-Lynn Pollock. Pages 676-679.
2. Nurbhai M, Grimshaw J, Watson M, Bond CM, Mollison JA, Ludbrook A. Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush) (Review). The Cochrane Collaboration. Issue 1: 2009.
3. Coric M, Barisic D, Lovric H. Fluconazole versus 3-day clotrimazole in the treatment of sporadic and recurrent vulvovaginal candidiasis. International Journal of Gynecology and Obstetrics. 2006: 95; 171-172.
4. Mendling W, Krauss C, Fladung B. A clinical multicenter study comparing efficacy and tolerability of topical combination therapy with clotrimazole (Canesten®, two formats) with single dose fluconazole (Diflucan®) in vulvovaginal mycoses. Mycoses. 2004: 47; 136-142.
5. Sekhavat L, Tabatabaii A, Tezerjani FZ. Oral fluconazole 150 mg single dose versus intra-vaginal clotrimazole treatment of acute vulvovaginal candidiasis. Journal of Infection and Public Health. 2011: 4; 195-199.
6. Canadian Guidelines on Sexually Transmitted Infections. Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada 2008. Section 4: Management and Treatment of Specific Syndromes- Vaginal Discharge (Bacterial vaginosis, Vulvovaginal candidiasis, Trichomoniasis). Vulvovaginal Candidiasis. Shelly Sarwal, MD. Page 9.
7. Therapeutic Choices. 5th Edition. Canadian Pharmacists Association 2007. Chapter 104 – Sexually Transmitted Infections. Natasha Press. Page 1351.
8. Lexi-comp Online, Hudson, Ohio: Lexi-Comp, Inc., 2012. http://online.lexi.com. Accessed May 2012.
9. E-CPS. Canadian Pharmacists Association, 2012. Accessed May 2012.
Clotrimazole should be considered as a first line agent in the treatment of uncomplicated vulvovaginal candidiasis in cases appropriate for self-care 1. Intra-vaginal treatment with clotrimazole has been shown to be equally effective to a single dose treatment of fluconazole 2, 3, 4. There are also no significant differences in effectiveness between single-dose and multiple-dose treatments with intra-vaginal antifungals such as clotrimazole 2. Although there were limitations to the primary literature reviewed, the results were comparable to the oral alternative 3, 4. Clotrimazole has known efficacy against C. albican 5. It also has a history of effective use for uncomplicated vulvovaginal candidiasis and is a first line recommendation by experts 1, 6.
Clotrimazole is safe in most populations, including women who are pregnant or breastfeeding, however it is not recommended during the first trimester of pregnancy 7. It is recommended that in pregnancy, a lower strength formulation should be used for a longer duration of time rather than the higher concentrations available (for example: 1% cream for 7 days). Since it is minimally absorbed systemically, there are no significant drug interactions 8. Clotrimazole should be avoided in patients who have had a previous hypersensitivity reaction to the formulation 8, 9. Clotrimazole should not be used as a first line agent in persistent cases or in women with additional complications 1 (please refer to red flags).
References:
1. Patient Self-Care. 1st Edition. Canadian Pharmacists Association 2002. Chapter 50 – Vaginal Symptoms. Laura-Lynn Pollock. Pages 676-679.
2. Nurbhai M, Grimshaw J, Watson M, Bond CM, Mollison JA, Ludbrook A. Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush) (Review). The Cochrane Collaboration. Issue 1: 2009.
3. Coric M, Barisic D, Lovric H. Fluconazole versus 3-day clotrimazole in the treatment of sporadic and recurrent vulvovaginal candidiasis. International Journal of Gynecology and Obstetrics. 2006: 95; 171-172.
4. Mendling W, Krauss C, Fladung B. A clinical multicenter study comparing efficacy and tolerability of topical combination therapy with clotrimazole (Canesten®, two formats) with single dose fluconazole (Diflucan®) in vulvovaginal mycoses. Mycoses. 2004: 47; 136-142.
5. Sekhavat L, Tabatabaii A, Tezerjani FZ. Oral fluconazole 150 mg single dose versus intra-vaginal clotrimazole treatment of acute vulvovaginal candidiasis. Journal of Infection and Public Health. 2011: 4; 195-199.
6. Canadian Guidelines on Sexually Transmitted Infections. Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada 2008. Section 4: Management and Treatment of Specific Syndromes- Vaginal Discharge (Bacterial vaginosis, Vulvovaginal candidiasis, Trichomoniasis). Vulvovaginal Candidiasis. Shelly Sarwal, MD. Page 9.
7. Therapeutic Choices. 5th Edition. Canadian Pharmacists Association 2007. Chapter 104 – Sexually Transmitted Infections. Natasha Press. Page 1351.
8. Lexi-comp Online, Hudson, Ohio: Lexi-Comp, Inc., 2012. http://online.lexi.com. Accessed May 2012.
9. E-CPS. Canadian Pharmacists Association, 2012. Accessed May 2012.