Use of locally delivered dequalinium chloride in the treatment of vaginal infections: a review.

Werner Mendling,Ernst Rainer Weissenbacher,Stefan Gerber,Philipp Grob,Valdas Prasauskas

doi:10.1007/s00404-015-3914-8

Werner Mendling, Ernst Rainer Weissenbacher + Show 3 more

Open Access

https://doi.org/10.1007/s00404-015-3914-8

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Abstract

BackgroundVaginal infections are responsible for a large proportion of gynaecological outpatient visits. Those are bacterial vaginosis (BV), vulvovaginal candidosis (VVC), aerobic vaginitis (AV) associated with aerobic bacteria, and mixed infections. Usual treatments show similar acceptable short-term efficacy, but frequent recurrences and increasing microbial resistance are unsolved issues. Furthermore, vaginal infections are associated with a variety of serious adverse outcomes in pregnancy and generally have a major impact on quality of life. Identifying the correct therapy can be challenging for the clinician, particularly in mixed infections.FindingsDequalinium chloride (DQC) is an anti-microbial antiseptic agent with a broad bactericidal and fungicidal activity. Systemic absorption after vaginal application of DQC is very low and systemic effects negligible. Vaginal DQC (Fluomizin®vaginal tablets) has been shown to have equal clinical efficacy as clindamycin in the treatment of BV. Its broad antimicrobial activity makes it appropriate for the treatment of mixed vaginal infections and in case of uncertain diagnosis. Moreover, resistance of pathogens is unlikely due to its multiple mode of action, and vaginal DQC provides also a reduced risk for post-treatment vaginal infections.ConclusionsVaginal DQC (10 mg) as 6-day therapy offers a safe and effective option for empiric therapy of different vaginal infections in daily practice. This review summarizes the available and relevant pharmacological and clinical data for the therapy of vaginal infections with vaginal DQC and provides the rationale for its use in daily gynaecologic practice.

Highlights

The human vaginal microbiome is mainly dominated by lactobacilli, depending on the ethnic background of women, and consists of probably more than 250 other different species of bacteria in lower quantities [1, 2]
Background Vaginal infections are responsible for a large proportion of gynaecological outpatient visits
Disturbed or abnormal vaginal flora is divided into vaginal infections which are localised and affect mainly to the vagina, sometimes disease can spread further to other organs

Summary

Introduction

The human vaginal microbiome is mainly dominated by lactobacilli, depending on the ethnic background of women, and consists of probably more than 250 other different species of bacteria in lower quantities [1, 2]. As alternative therapy broad spectrum antimicrobial agents, such as dequalinium chloride (DQC), are used to treat vaginal infections. Della Casa and colleagues demonstrated the in vitro antimicrobial activity of DQC against different pathogens that are relevant for vaginal infections, including anaerobic bacteria (Gardnerella vaginalis, Bacteroides spp., Peptostreptococcus spp., etc.), aerobic bacteria (staphylococci, streptococci, Escherichia coli, etc.), Candida species (C. albicans, C. glabrata, etc.) and Trichomonas vaginalis [69]. The broad spectrum antimicrobial activity covering all relevant pathogens for vaginal infections and the negligible systemic absorption are the key factors of DQC to make it suitable for the treatment of most vaginal infections. More than 3000 women with vaginal infections of different aetiology have been treated

76: Mixed infection—76

Summary and conclusions

Findings

Compliance with ethical standards