PHARMACOTHERAPY PRINCIPLES AND PRACTICE CARE PLANS & CASES
Upon completion of the chapter, the reader will be able to:
Explain the underlying pathophysiology of vulvovaginal candidiasis, oropharyngeal candidiasis, esophageal candidiasis, and fungal skin infections.
Identify symptoms of vulvovaginal candidiasis, oropharyngeal candidiasis, esophageal candidiasis, and fungal skin infections.
Identify the desired therapeutic outcomes for patients with uncomplicated and complicated vulvovaginal candidiasis, oropharyngeal candidiasis, esophageal candidiasis, and fungal skin infections.
Recommend appropriate lifestyle modifications and pharmacotherapy interventions for patients with vulvovaginal candidiasis, oropharyngeal candidiasis, esophageal candidiasis, and fungal skin infections.
Recognize when long-term suppressive therapy is indicated for a patient with vulvovaginal candidiasis.
Recognize when topical versus oral treatment is indicated for a patient with oropharyngeal candidiasis, esophageal candidiasis, vulvovaginal candidiasis, and fungal skin infections.
Educate patients about the disease state, appropriate lifestyle modifications, and medication therapy required for effective treatment of vulvovaginal candidiasis, oropharyngeal candidiasis, esophageal candidiasis, and fungal skin infections.
Superficial fungal infections, also referred to as mycoses, are common and treatable conditions seen in everyday practice. Treatment largely depends on the use of azole and allylamine antifungal agents, either topically or orally, depending on the site, severity, and immune status of the patient.
Vulvovaginal candidiasis (VVC), whether symptomatic or asymptomatic, refers to infections in women whose vaginal cultures are positive for Candida species.
EPIDEMIOLOGY AND ETIOLOGY
Vulvovaginal candidiasis, also known as moniliasis, is a common form of vaginitis, accounting for 20% to 25% of vaginitis cases. Although VVC is uncommon prior to menarche, an estimated 75% of women will have at least one occurrence of VVC.1
According to the treatment guidelines of the Centers for Disease Control and Prevention (CDC),1 VVC can be classified as uncomplicated or complicated. Uncomplicated infections occur sporadically, cause mild to moderate symptoms, and occur in nonimmunocompromised women. Uncomplicated infections, most often caused by Candida albicans, often have no identifiable precipitating cause. Complicated infections, including recurrent, severe infections, and those in women with uncontrolled diabetes, debilitation, or immunosuppression, may be caused by nonalbicans or azole-resistant fungal organisms. Recurrent VVC, defined as four or more infections per year, occurs in less than 5% of women, is distinguishable from a persistent infection by the presence of a symptom-free interval between infections.1
KEY CONCEPT Candida albicans is the primary pathogen responsible for VVC, accounting for 66% of cases.2 Other cases are caused by nonalbicans species, including Candida glabrata, Candida tropicalis, Candida krusei, and Candida parapsilosis.2
Clinical Presentation and Diagnosis of VVC
Patients with VVC may present with vulvar and/or vaginal symptoms. Symptoms often develop the week before menses and resolve with the onset of menses. Symptoms