IN VITRO ANTIFUNGAL SENSITIVITY OF FLUCONAZOLE, CLOTRIMAZOLE AND NYSTATIN AGAINST VAGINAL CANDIDIASIS IN FEMALES OF CHILDBEARING AGE
AbstractBackground: Vaginal candidiasis is the most common infection of females. A large variety ofantifungal drugs are used for treatment. The objective of this study was isolation and identification ofCandida from high vaginal swabs and in vitro antifungal activity of Clotrimazole, Fluconazole andNystatin against Candida. Methods: Two hundred and fifty high vaginal swabs were collected fromfemales reporting at different hospitals of Karachi. Wet mount was performed to observe the buddingcells of Candida. Vaginal swabs were cultured on Sabouraud’s dextrose agar with added antibiotics.Plates were incubated at room temperature for seven days. Chlamydospores of Candida albicans wereidentified on corn meal agar. Species of Candida were identified on Biggy agar. In vitro antifungalactivity of Clotrimazole, Fluconazole and Nystatin was performed by MIC (Minimum inhibitoryconcentration), well diffusion method and disc diffusion method. Results: Out of 250 high vaginalswabs, Candida species were isolated in 100 (40%) of cases. Out of 100, C. albican 30 (30%), C.tropicalis 21 (21%), C. parapsillosis 10 (10%), C. parakrusi 8 (8%), C.glabrata 8 (8%), C. krusei 3 (3%)were isolated. In vitro antifungal activity indicated Clotrimazole (MIC 16 and 8 µg/ml) effective against68 (70%) of Candida SPP, Fluconazole (MIC 64 and 32 µg/ml) effective against 29 (36.2%) andNystatin disc (100 units) was 51 (63.5%) effective. Conclusion: C. albicans was mainly isolated.Clotrimazole was more effective as compared to Fluconazole and Nystatin. Antifungal susceptibilitytesting should be determined before therapy to avoid treatment failures.Keywords: Vaginal candidiasis, Antifungal sensitivity, Species of Candida
Lanchares JL, Hernande ML. Recurrent Vaginal Candidiasis
changes in etiopathogenical pattern. Int. J Gynecol and Obstet
Ferrer J. Vaginal candidosis: epidemiological and etiological
factors. Int J Gynecol Obstet 2000;71(Suppl-1):S21–7.
Ghannoum MA. Susceptibility testing of fungi and correlation
with clinical outcome. J Chemother 1997;9(1):19–24.
Ghannoum MA., Rex, J N. Galgiani. Susceptibility testing of
fungi: current status of correlation of in vitro data with clinical
outcome. J Clin Microbiol 1996;34:489–95.
CLSI. Reference Method for Broth Dilution Antifungal
Susceptibility Testing of Yeasts; Approved Standard-Second
Edition. CLSI document M27-A2 [ISBN 1-56238-469-4].
Pennsylvania, USA; CLSI; 2002.
Pavelic Z, Skalko-Basnet N, Jalsenjak I. Characterisation and in
vitro evaluation of bio adhesive liposome gels for local therapy of
vaginitis. Int J Pharm 2005;301:140–8.
Meis J, Petrou M, Bille J, Ellis D, Gibbs D. A global evaluation of
the susceptibility of Candida species to fluconazole by disk
diffusion. Ugeskr Laeger 2000;162:1907–8.
Mian UK, Mayers M, Garg Y, Liu QF, Newcomer G, Madu C, et
al. Comparison of fluconazole pharmacokineticsin serum,
aqueous humor, vitreous humor, and cerebrospinal fluid
following a single dose and at steady state. J Ocul Pharmacol
Pfaller MA., Diekema DJ, Jones RN, Sader HS, Fluit AC, Hollis
RJ, et al. International surveillance of bloodstream infections due
to Candida species: frequency of occurrence and in vitro
susceptibilities to fluconazole, ravuconazole, and voriconazole of
isolates collected from 1997 through 1999 in the SENTRY
antimicrobial surveillance program. J Clin Microbiol
Pfaller MA., Messer SA, Hollis RJ, Jones RN, Doern D, Brandt
ME, et al. Trends in species distribution and susceptibility to
Fluconazole among blood stream isolates of Candida species in
the United States. Diagn Microbiol Infect Dis 1999;33:217–22.
Rex JH, Walsh TJ, Sobel JD, Filler SG, Pappas PG, Dismukes
WE, et al. Practice guidelines for the treatment of candidiasis,
Infectious Diseases Society of America. J Parenter Enteral Nutr
J Ayub Med Coll Abbottabad 2010;22(4)
Richardson K, Cooper K, Marriott MS, Tarbit MH, Troke PF,
Whittle PJ.. Discovery of fluconazole, a novel antifungal agent.
Rev Infect Dis 1990;12:S267–S271.
Arikan S, Ostrosky-Zeichne l, Lozano-Chiu M, Paetznick V,
Gordon D, Wallace T, et al. In Vitro Activity of Nystatin
Compared with Those of Liposomal Nystatin, Amphotericin B,
and Fluconazole against Clinical Candida Isolates. J clin
Rex JH, Pfaller MA, Walsh TJ, Chaturvedi V, Espinel-Ingroff
A, Ghannoum MA, et al. Antifungal Susceptibility Testing:
Practical Aspects and Current Challenges. Clin Microbiol Rev
Grigoriou O, Baka S, Makrakis E. Prevalence of clinical vaginal
candidiasis in a university hospital and possible risk factor. Eur J
Obstet Gynecol Reprod Biol 2005;126:121–5.
Puri KJ, Madan A, Bajaj K. Incidence of various causes of
vaginal discharge among sexually active females in age group
–40 years. Indian J Dermatol Venereol Leprolo 2003;69:122–5.
Wenjin Q, Yifu S. Epidemiological study on vaginal Candida
glabrata isolated from pregnant women. Scand J Infectious Dis
Philips AJ. Treatment of non-albicans Candida vaginitis with
amphotericin B vaginal suppositories. Am J Obstet Gynecol
Hoffman HL, Pfaller MA. In vitro antifungal susceptibility
testing. Pharmacotherapy 2001;21:1115–235.
Tavallaee M, Rad MM. Fixed drug eruption resulting from
fluconazole use: a case report. J Med Case Reports 2009;3:7368.
Kikani BA, Kikani KM, Pathak SJ. Effects of chemically
synthesized azole compounds on clinical isolates of vaginal
candidiasis in comparision with commercially prepared antifungal
drugs. Internet J Microbiol 2008;4(2).
Matar MJ, Ostrosky-Zeichner L, Paetznick VL, Rodriguez JR,
Chen E, Rex JH. Correlation between E-test, disk diffusion and
micro dilution method for antifungal susceptibility testing of
fluconazole and voriconazole. Antimicrob Agents Chemother
Magaldi S, Meta-Essayag S, Hartung de capriles C, Perez C,
Colella M, Olaizola C. Well diffusion for antifungal susceptibility
testing. Int J Infect Dis 2004;8(1):39–45.
Sobel JD, Zervos M, Reed BD, Hooton T, Soper D, Nyirjesy P, et
al. Fluconazole Susceptibility of Vaginal Isolates Obtained from
Women with Complicated Candida Vaginitis: Clinical
Implications. Antimicrob Agents Chemother 2003;47:34–8.
Richter SS, Galask RP, Messer SA, Hollis RJ, Diekema DJ,
Pfaller MA. Antifungal Susceptibilities of Candida Species
Causing Vulvovaginitis and Epidemiology of Recurrent Cases. J
Clin Microbiol 2005;43:2155–62.
Verghese S, Padmaja P, Asha M, Elezebeth SJ, Anith A,
Kandawi KM, et al. Prevalance, species distribution and
antifungal sensitivity of vaginal yeast in infertile women. Indian J
Pathol Microbiol 2001;43:313–4.
Fan SR, Liu XP, Li JW. Clinical characteristics of vulvovaginal
candidiasis and antifungal susceptibilities of Candida species
isolates among patients in southern China from 2003 to 2006. J
Obstet Gynaecol Res 2008;34:561–6.
Bahadori F, Broomand F, Diba K, Yekta Z, Namaki A.
Comparision of fluconazole and clotrimazole in the treatment of
acute Candida albicans vulvovaginitis. J family Reprod Health
Mikamo H, Kawazoe K, Sato Y, Hayasaki Y, Tamaya T.
Comparative Study on the Effectiveness of Antifungal Agents in
Different Regimens against Vaginal Candidiasis. Chemotherapy