The efficacy and safety of fenticonazole in the treatment of mixed vaginitis

Abstract

Background: Vaginitis means inflammation of the vaginal mucosa and is one of the most common causes for consulting to a gynecologists. Mixed-type vaginal infections are simultaneous infections of at least two types of vaginal pathogens (for example, a bacteria and a Candida species). In the treatment of mixed vaginitis, broad spectrum antimicrobial therapy effective on different kinds of pathogens is required. Aim: The purpose of this review is to evaluate the place and efficacy of fenticonazole nitrate (2% vaginal cream and 600 mg pessary forms) in mixed-type vaginitis. Method: Literatures were retrieved by a PubMed search, using different combinations of pertinent keywords (e.g., fenticonazole, fungal infection, mixed vaginal infections), without any limitations in terms of publication date and language. Papers which assessed the therapeutic efficacy and tolerability of fenticonazole in patients with mixed vaginitis were selected for inclusion according to their relevance for the topic, as judged by the authors. Results: Fenticonazole has a broad spectrum of activity, including antifungal, antibacterial and antiparasidic effects. Fenticonazole nitrate provides significant improvement in symptoms such as vaginal discharge, pruritus and burning associated with candidal vulvovaginitis, with a cure rate of 97.5%. In addition, while fenticonazole provides 85% cure rates in bacterial vaginitis, it is an effective topical option with a clinical cure rate of 87% in mixed vulvovaginal infections with Candida albicans, Gardnerella vaginalis and/ or Trichomonas vaginalis. Fenticonazole provides up to 90% improvement in symptoms such as pruritus, burning, redness, discharge and edema, which are frequently observed in vaginitis, with its rapid onset of action and excellent tolerability from the first days of treatment. Conclusion: Fenticonazole has a broad spectrum of antimicrobial activity with its antifungal, antibacterial and antiparasidic effects. It is an ideal topical alternative with its high clinical efficacy in Candidal vulvovaginitis caused by Candida albicans, bacterial vaginosis caused by Gardnerella vaginalis, gram (+) and/or gram (-) bacteria, and Trichomonal vaginitis caused by Trichomonas vaginalis and mixed vaginitis caused by these pathogens and its excellent tolerability. Fenticonazole has lower efficacy against the three main lactobacillus strains called Lactobacillus gasseri, Lactobacillus jensenii and Lactobacillus crispatus found on the vaginal flora compared to miconazole and metronidazole with high MID rates. Fenticonazole is a treatment option with efficacy, safety and excellent tolerability that can be the first choice empirically in the first-line treatment of mixed-type vaginitis, which has been shown to be effective in fungal, bacterial and mixed-type vaginal infections with its broad spectrum of action in various clinical studies.