MICONAZOLE
Place in Therapy
Place in Therapy
Miconazole is considered first line therapy for uncomplicated cases of vulvovaginal candidiasis and is appropriate for self-care 1,2,3. There are no differences between the efficacy and safety profile of topical azoles in the treatment of VVC and thus product selection is based on patient preferences 1,2. Treatment with azoles results in relief of symptoms and negative cultures in 80%-90% of patients who complete therapy3. Additionally, there are no differences in efficacy between different lengths of treatment of uncomplicated cases2,3,4. Data has shown that topical azoles, including miconazole is more effective than nystatin4,6. Intra-vaginal treatment with miconazole is as effective as oral fluconazole single dose of 150 mg5. The most common side effects include local burning and irritation1,2,3,4.
Topical azoles including miconazole is considered safe in pregnancy, uncontrolled diabetes and HIV2,3. For pregnant women treatment for 7-14 days is recommended 2,3. Immunocompromised patients also do not response well to short-term therapy and should be treated for 7-14 days3.
References
1. Patient Self-Care. 1st Edition. Canadian Pharmacists Association 2002. Chapter 50 – Vaginal Symptoms. Laura-Lynn Pollock. Pages 676-679.
2. Joseph T. DiPiro, Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael Posey. Pharmacotherapy: A Pathophysiologic Approach, 8th Edition. Chapter 129: Superficial Fungal Infections. Toronto: McGraw-Hill; 2011.
3. Centers for Disease Control and Prevention (CDC). Diseases characterized by vaginal discharge. In: Sexually transmitted diseases treatment guidelines, 2010 [Erratum appears in MMWR Recomm Rep. 2011 Jan 14;60(1):18]. MMWR Recomm Rep 2010 Dec 17;59(RR-12):56-63.
4. Miconazole. Micromedex® Healthcare Series [Internet database]. Greenwood Village, Colo: Thomson Healthcare. Updated periodically.
5. Van Heusden AM, Merkus HM, Ruud SA, et al. Single-dose oral fluconazole versus single-dose topical miconazole for the treatment of acute vulvovaginal candiosis. Acta Obstet Gynecol Scand. 1990: 69;417-422.
6. Hilton AL, Warnock DW, Milne JD, Scott AJ. Treatment of vaginal candidiasis with miconazole. Current Medical Research and Opinion. 1978: 5;295-298.
Miconazole is considered first line therapy for uncomplicated cases of vulvovaginal candidiasis and is appropriate for self-care 1,2,3. There are no differences between the efficacy and safety profile of topical azoles in the treatment of VVC and thus product selection is based on patient preferences 1,2. Treatment with azoles results in relief of symptoms and negative cultures in 80%-90% of patients who complete therapy3. Additionally, there are no differences in efficacy between different lengths of treatment of uncomplicated cases2,3,4. Data has shown that topical azoles, including miconazole is more effective than nystatin4,6. Intra-vaginal treatment with miconazole is as effective as oral fluconazole single dose of 150 mg5. The most common side effects include local burning and irritation1,2,3,4.
Topical azoles including miconazole is considered safe in pregnancy, uncontrolled diabetes and HIV2,3. For pregnant women treatment for 7-14 days is recommended 2,3. Immunocompromised patients also do not response well to short-term therapy and should be treated for 7-14 days3.
References
1. Patient Self-Care. 1st Edition. Canadian Pharmacists Association 2002. Chapter 50 – Vaginal Symptoms. Laura-Lynn Pollock. Pages 676-679.
2. Joseph T. DiPiro, Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael Posey. Pharmacotherapy: A Pathophysiologic Approach, 8th Edition. Chapter 129: Superficial Fungal Infections. Toronto: McGraw-Hill; 2011.
3. Centers for Disease Control and Prevention (CDC). Diseases characterized by vaginal discharge. In: Sexually transmitted diseases treatment guidelines, 2010 [Erratum appears in MMWR Recomm Rep. 2011 Jan 14;60(1):18]. MMWR Recomm Rep 2010 Dec 17;59(RR-12):56-63.
4. Miconazole. Micromedex® Healthcare Series [Internet database]. Greenwood Village, Colo: Thomson Healthcare. Updated periodically.
5. Van Heusden AM, Merkus HM, Ruud SA, et al. Single-dose oral fluconazole versus single-dose topical miconazole for the treatment of acute vulvovaginal candiosis. Acta Obstet Gynecol Scand. 1990: 69;417-422.
6. Hilton AL, Warnock DW, Milne JD, Scott AJ. Treatment of vaginal candidiasis with miconazole. Current Medical Research and Opinion. 1978: 5;295-298.