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Terconazole vs. fluconazole for treatment of candidiasis
The triazole antifungal drugs terconazole and fluconazole are more effective than the imidazoles against yeasts causing vulvovaginal candidiasis.
The triazoles generally require shorter drug regimens and are associated with lower rates of relapse and higher rates of cure. Given the wide spectrum of yeasts other than Candida albicans that are associated with vulvovaginitis, one or more species may be resistant to antifungal agents. With the widespread use of fluconazole, cases of resistant isolates of C. albicans and the appearance of infection by species of yeasts other than albicans have been reported. Cooper and McGinnis evaluated yeast isolates to determine in vitro susceptibility to terconazole and fluconazole.
Fifty clinical yeast isolates of C. albicans, Candida krusei, Candida parapsilosis, Candida tropicalis and Torulopsis glabrata were evaluated. A standardized broth macrodilution was used to determine the minimal inhibitory concentrations of terconazole and fluconazole.
For all species, the minimum inhibitory concentrations of terconazole were significantly lower than those of fluconazole. For each individual isolate, the minimum inhibitory concentration of terconazole was consistently lower than the corresponding concentration for fluconazole. Differences in the geometric mean of terconazole and fluconazole minimum inhibitory concentrations were most significant for C. krusei and T glabrata, followed by C. parapsilosis, C. tropicalis and C. albicans.