Monthly Itraconazole Versus Classic Homeopathy for the Treatment of Recurrent Vulvovaginal Candidiasis A Randomized Trial COMMENT

When used to treat acute infections of vulvovaginal candidiasis as well as maintenance therapy to prevent recurrence, oral or topical antifungal agents of the azole group lower the incidence of and cure most of the infections. Cessation of maintenance treatment, however, results in recurrent vulvovaginal candidiasis (RVVC) within 6 months in about 50% of women. Classic homeopathy (CH) is a widely used controversial alternative treatment for RVVC, but there is little objective data demonstrating its effectiveness. Two previous studies reported that oral and intravaginal administration of Lactobacillus acidophilus in women with RVVC was associated with some subjective and objective improvements. This prospective, single center, randomized trial was a 12-month study that compared the effectiveness of monthly cycle-dependent itraconazole with and without lactobacilli and CH in reducing the frequency of clinical episodes of RVVC in 150 women with prior episodes. Patients positive for Candida albicans were randomly assigned to receive either itraconazole/lactobacilli (group 1), itraconazole monotherapy (group 2), or CH alone (group 3). Induction therapy for an acute infection for both group 1 and 2 patients consisted of single-day doses of itraconazole 200 mg b.i.d. This dose was continued during 6 months of maintenance therapy in groups I and 2; additionally, group 1 patients were given a suppository containing lactobacilli intravaginally. The women in groups I and 2 received no further treatment. Group 3 patients were treated using a single homeopathic remedy during the entire 12 months. Patients' RVVC related-complaints and their level of satisfaction with therapy was evaluated using a visual analogue scale. The absence of vulvovaginal candidiasis in vaginal culture was achieved significantly earlier among women in groups I and 2 than those in group 3 (log-rank test; P < 0.0001). Following induction therapy before the start of the maintenance regimen, 40 of 47 women (85%) in group I and 44 of 49 women (89.8%) in group 2 were free of Candida detectable in culture. Women in group 3 had a recurrence of the infection significantly earlier than women in the both groups I and 2 (log-rank test; P = 0.002). At 12 months, 78% (18/23) of the women in group 1, 76%, (19/25) of those in group 2, and 39% (9/29) of those in group 3 were free of Candida in culture. The level of discomfort from RVVC and dissatisfaction with therapy was significantly higher among women in group 3 than those in groups I and 2 (P < 0.001). These findings are consistent with other earlier studies showing that itraconazole is more effective for treatment of RVVC than classic homeopathy. There was no added benefit with lactobacilli.