Relating to Marlene Heinz, Symp. Adv. Infect., XIII World Congress Ped. Adol. Gyn. and VII ALOGIA Congress, Buenos Aires (2001)
Treatment of relapsed or recurrent candidiasis (RC) in adolescent girls means to deal with fortunately seldom but not less bothering disorders. It is a rare occurence, less than 1 % of the girls affected by candidiasis have one or more relapses. They suffer from insatiable itching and soreness over months or even years, the associated mental stress increases over time.
Treatment depends on the diagnosis and on the identification of the causative Candida species. Patients with heavy discomfort or with repeated relapses should be treated referring to following scheme like measures.
| Scheme of treatment in RC as separated or combined measures | ||
|---|---|---|
| Cause | Applicate | Agents |
| 1. Extragenital infestation 2. Vaginal infestation 3. Vaginal infestation 4. Local vaginal immundeficiency |
oral oral intravag. vacc. |
polyene antibiotics azole derivatives pyridone derivatives inactivated vaccine |
| If indicated apply all simultaneously! | ||
| Treatment of extragenital infestation with antibiotics |
|---|
| Oral germ identity 4 x 100 mg Amphotericin-B-lozenges daily or 4 x 100.000 IE Nystatin mouth gel daily |
| Intestinal germ identity 4 x 100 mg Amphotericin-B film-tablets daily or 4 x 500.000 IE Nystatin film-tablets daily |
| Treatment of carious teeth Treatment of boyfriend too |
| Oral treatment of vaginal infestation with azoles dependent on germ sensibility to triazoles (Application: 2 weeks at least) |
||||
|---|---|---|---|---|
| Germ | Sensibility to | Recommended | Dosage | |
| Fluconazole | Itroconazole | Triazole | mg/d | |
| C. albicans* C. glabrata C. krusei C. tropicalis C. parapsil. |
+++ + ------- +++ +++ |
+++ ------- +++ +++ +++ |
Fluconazole Fluconazole Itroconazole Fluconazole Fluconazole |
100 - 200 800 200 100 - 200 100 - 200 |
| * C. albicans treatment with imidazoles also possible | ||||
| Intravaginal treatment of infestation with Ciclopiroxolamine (CPX) (pyridone derivative) |
||
|---|---|---|
| CPX dosage | applicate | duration |
| 50 mg (= 5 mg Creme) or 100 mg (= 1 supp) |
intravaginal intravaginal |
daily: for 10 - 14 d daily: for 6 d |
| Ciclopiroxolamine: towards e. g.: |
broad activity spectrum C. glabrata, C. krusei pseudomonas aeruginosa proteus mirabilis |
|
| Treatment of local immunodeficiency with inactivated vaccine |
|---|
| Agent - Inactivated germs of eight aberrant varieties of lactobacillus |
| Mode of action - Induction of development of specific antibodies against aberrent varieties of the Doederlein's bacillus |
| Dosage - 3 x 1 amp. i. m. every second week = basic - 1 amp. after one year = booster |
| Scheme of prevention of reinfection |
|---|
|
| Not to forget: - healthy balances roughage accumulated food - no general withdrawal from sugar in the food |