A. Süha SÖNMEZ, Feza BURAK, Ömür TAŞKIN, Ali BUHUR, Emine SÖNMEZ

Vulvovajinal kandidiyazis tedavisinde sistemik tek-doz ile lokal tek- doz antifungal tedavinin etkinliği

Tüm kadınların %75'inin ömürleri boyunca en az bir kez vulvovajinal kandidiyazis ile karşılaşacakları düşünülürse böyle büyük bir hasta sayısını tedavi etmenin hem maliyet hem de iş gücü kaybı açısından oldukça önemli bir sorun olarak devam ettiği görülmektedir. Bu nedenle bu hasta populasyonunda tedavi süresinin kısaltılması önemlidir. Buradan hareketle, bu prospektif çalışma seçilen tek-doz sistemik ve lokal tedavinin etkinliğini araştırmak amacıyla planlanmıştır. Klinik ve mikrobiyolojik olarak kandida vajinitis tesbit edilen, reprodüktif çağda, 92 hasta çalışmaya dahil edildi. Bunlardan gebe olmayan 37 tanesine sistemik (peroral) tek doz flukonazol (150 mg/1 gün), 40 tanesine lokal (intravajinal) tek doz izokonazol (300 mgl' 1 gün)verildi. Lokal uygulama yapılan hastaların 25 tanesi gebe olup 2. veya 3. trimesterde idi. 15 hasta ise kontrol grubu olarak seçildi ve uzun süreli sistemik ketokonazol (400 mg/gün) 5 gün süreyle verildi. Hastalar tedaviden 10 gün sonra kontrole çağrıldı ve vajen kültürü alındı. Sistemik tedavi alan 37 hastanın 4 . 34'ünde (%91.8), lokal tedavi alan 40 hastanın 33'ünde (%82.5) semptomatik ve mikolojik tam iyileşme tesbit edildi. Uzun süreli tedavi grubunda ise 15 hastanın 13'ü (%86.6) tam şifa buldu. Gruplar arasında istatistiksel yönden anlamlı fark bulunamadı (p>0.05, Fisher kesin ki-kare testi). Sonuç olarak uzun süreli sistemik tedavinin, sistemik ve lokal tek doz tedaviye üstün olmadığı tesbit edildi. Tedavi süresi ve yan etkiler açısından kısa süreli tedavinin daha kazançlı bulunması nedeniyle tercih edilmesi gerektiği sonucuna varıldı. [Turgut Özal Tıp Merkezi Dergisi 1996;3(2):93-96]

The efficacy of single-dose systemic and single-dose local antifungal therapy in the treatment of vulvovaginal candidiasis

If 75% of all women are considered to be suffered from vulvovaginal candidiasis at least one episode during their lifetime, it seems to be a great problem to treat this population in terms of cost and time demand. For this reason, it is important to shorten the time to treat this disease. From this standpoint, this prospective study was planned to search the efficacy of single-dose oral and local therapy. Ninety-two patients with clinically and microbiologically proven candidal vaginitis, in reproductive age, were included in the study. Thirty-seven nonpregnant women were given oral single-dose fluconazole (150 mg/lday), and 40 women had intravaginal single-dose isoconazole (300 mg/1 day). Twenty-five out of 40 were pregnant in 2nd or 3rd trimester. Fifteen patients served as controls and had oral ketoconazol (400 mg/day) for 5 days. Patients were evaluated 10 days later and vaginal culture was repeated. Symptomatic and mycologic cure was attained by 91.8% of the fluconazole group, 82.5% of isoconazole group, and 86.6% of ketoconazole group. A statistically significant difference did not exist for any of these measures (p>0.05, Fisher's exact test). As a conclusion, long-term therapy is not superior to single-dose therapy. Therefore, single-dose therapy seems to be beneficial in terms of time demand, cost and adverse effects. [Journal of Turgut Özal Medical Center 1996;3(2):93-96]

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