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Antimicrobials during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
There are no large studies of the use of these three antifungal agents during pregnancy. Butoconazole is a category B drug, and their manufacturers list the other two as category C. It seems unlikely that these agents would have significant, if any, teratogenic risks.
Candida and parasitic infection: Helminths, trichomoniasis, lice, scabies, and malaria
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Treatment of Candida vulvovaginitis in pregnancy is typically limited to topical azoles and nystatin (16,25). For many years, nystatin was the primary drug used for Candida vulvovaginitis in pregnancy because its extremely poor absorption was felt to improve its safety (pregnancy category B) (25). As studies have proven, the increased efficacy of the azole antifungal agents, miconazole, clotrimazole, butoconazole, and terconazole, has become the mainstays of therapy in pregnancy. They have been used extensively in human pregnancy with no adverse effects or increase in congenital malformations noted, but most remain pregnancy category C due to the absence of adequate controlled human studies. There is no clear leader from this group in terms of efficacy and patient satisfaction, so selection may be based on availability and cost. Seven-day treatment is usually needed in pregnancy due to the higher rates of treatment failure and recurrence. Cure rates are typically 5% to 10% lower than those in nonpregnant women for the same dosing regimen.
Topical Azoles
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Joanne L. Sharp, Michael A. Pfaller
Local adverse effects are experienced by about 4% of patients treated with bifonazole (Lackner and Clissold, 1989; Alomar et al., 1995). Approximately 2% of women in clinical trials experienced local reactions to butoconazole (Bradbeer et al., 1985). Clotrimazole is usually well tolerated but some local reactions have been described (see Table 161.3) (Spiekermann and Young, 1976). Cross-reactivity with other imidazoles used as topical agents is rarely observed (Kalb and Grossman, 1985; Raulin and Frosch, 1988). Small amounts of clotrimazole are absorbed from the vagina. Patients have described a flu-like syndrome when administered both the vaginal cream and the suppository of terconazole (Geiger, 1988; Hyder et al., 1994). Clinical trials have demonstrated excellent safety and efficacy of 10% efinaconazole in the treatment of onychomycosis. Most topical azoles have shown some local reactions, and these are summarized in Table 161.3 (Gupta and Paquet, 2014; Gupta and Simpson, 2014; Lipner and Scher, 2015).
Current treatment options for vulvovaginal candidiasis caused by azole-resistant Candida species
Published in Expert Opinion on Pharmacotherapy, 2018
The use of available topical azole agents, creams, or suppositories miconazole, clotrimazole, butoconazole, and terconazole can be tried but little information of the efficacy of these older agents is available. In the presence of cross-resistance to oral agents, resistance to all agents in the azole drug class is likely. Once more, maintenance of long-term regimens with topical agents is inconvenient and largely untested.
Miconazole for the treatment of vulvovaginal candidiasis. In vitro, in vivo and clinical results. Review of the literature
Published in Journal of Obstetrics and Gynaecology, 2023
Pedro Antonio Regidor, Manopchai Thamkhantho, Chenchit Chayachinda, Santiago Palacios
Miconazole nitrate, an imidazole derivative, is a synthetic azole antifungal agent that is structurally related to other imidazole-derivative azole antifungal agents (e.g. butoconazole, clotrimazole, econazole, ketoconazole, oxiconazole, sulconazole and tioconazole).