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Local Probiotic Therapy for Vaginal Candida albicans Infections


The high rate of vaginal Candida albicans recurrence is attributed to azole resistance rates as high as 15 %. The aim of this study was to determine the clinical and microbiological efficacy of standard azole therapy for treatment of vaginal C. albicans infection alone and in combination with local probiotic as well as the effects on vaginal microbiota. This study included 436 women with vaginal candidiasis randomly assigned to two treatment groups. The first group, with 207 patients (12 dropouts), was administered 150 mg fluconazole and a single vaginal globule of fenticonazole (600 mg) on the same day. The second group of 209 patients (8 dropouts) followed the same treatment schedule; however, ten applications of a vaginal probiotic containing Lactobacillus acidophilus, L. rhamnosus, Streptococcus thermophilus, and L. delbrueckii subsp. bulgaricus were also administered beginning the fifth day after azole treatment. Microbiological analysis of the therapy efficacy in the first treatment group showed C. albicans resistance in over 30 % of patients. Clinical complaints persisted after treatment administration in 79.7 % (n = 165) of women in this group. Clinical complaints in the second group decreased to 31.1 % (n = 65) and microbiological efficacy also improved among investigated parameters, from 93.7 % (n = 193) to 95.2 % (n = 198). The local application of probiotics after administration of combined azoles for treatment of vaginal C. albicans infections increases therapy efficacy and could prevent relapse.

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  1. 1.

    Hogan DA, Kolter R (2006) Bacterial-fungal interactions in the female reproductive tract. Molecular principles of fungal pathogenesis. ASM Press, Washington, DC, pp 266–267

    Google Scholar 

  2. 2.

    Monif GRG, Baker DA (2004) Candida albicans. Infectious diseases in obstetrics and gynecology, 5th edn. The Parthenon Publishing Group, Nashville, pp 405–421

    Google Scholar 

  3. 3.

    Mitchell TG (2010) Medical mycology. Jawetz, Melnick and Adelberg’s medical microbiology, 25th edn. The McGraw-Hill Companies Inc., New York, pp 623–661

    Google Scholar 

  4. 4.

    Vermitsky JP, Self MJ, Chadwick SG, Trama JP, Adelson ME, Mordechai E, Gygax SE (2008) Survey of vaginal-flora Candida species isolates from women of different age groups by use of species-specific PCR detection. J Clin Microbiol 46:1501–1503

    Article  Google Scholar 

  5. 5.

    Hidalgo JA, Vazquez JA (2008) Candidiasis. Accessed 16 Oct 2014

  6. 6.

    Kovachev S, Nacheva A, Vacheva-Dobrevska R, Vasilev N (2009) Combined single-day treatment in acute vulvovaginal candidosis. Akush Ginekol (Sofiia) 48:18–23

    Google Scholar 

  7. 7.

    Fan SR, Liu XP (2011) In vitro fluconazole and nystatin susceptibility and clinical outcome in complicated vulvovaginal candidosis. Mycoses 54:501–505

    CAS  Article  Google Scholar 

  8. 8.

    Ge SH, Wan Z, Li J, Xu J, Li RY, Bai FY (2010) Correlation between azole susceptibilities, genotypes, and ERG11 mutations in Candida albicans isolates associated with vulvovaginal candidiasis in China. Antimicrob Agents Chemother 54:3126–3131

    CAS  Article  Google Scholar 

  9. 9.

    Richter SS, Galask RP, Messer SA et al (2005) Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of reccurrent cases. J Clin Microbiol 43:2155–2162

    CAS  Article  Google Scholar 

  10. 10.

    Martinez RCR, Franceschini SA, Patta MC et al (2009) Improved treatment of vulvovaginal candidiasis with fluconazole plus probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. Lett Appl Microbiol 48:269–274

    CAS  Article  Google Scholar 

  11. 11.

    Reid G, Beuerman D, Heinemann C, Bruce AW (2001) Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora. FEMS Immunol Med Microbiol 32:37–41

    CAS  Article  Google Scholar 

  12. 12.

    CDC and Prevention Treatment Guidelines (2010). MMWR. 59: No. RR-12

  13. 13.

    Mazneĭkova V (2003) Vaginal candidiasis–treatment protocols using miconazole and fluconazole. Akush Ginekol (Sofiia) 42(Suppl 2):30–34

    Google Scholar 

  14. 14.

    Sobel JD, Zervos M, Reed BD et al (2003) Fluconazole susceptibility of vaginal isolates obtained from women with Candida vaginitis: clinical implications. Antimicrob Agents Chemother 47:34–38

    CAS  Article  Google Scholar 

  15. 15.

    Köhler GA, Assefa S, Reid G (2012) Probiotic interference of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 with the opportunistic fungal pathogen Candida albicans. Infect Dis Obstet Gynecol 2012:636474

    Article  Google Scholar 

  16. 16.

    Osset J, Garcia E, Bartolome RM et al (2001) Role of Lactobacillus as protector against vaginal candidiasis. Med Clin 117:285–288

    CAS  Article  Google Scholar 

  17. 17.

    Strus M, Kuchaska A, Kukla G, Brzychczy-Wloch M, Maresz K, Heczko PB (2005) The in vitro activity of vaginal Lactobacillus with probiotic properties against Candida. Infect Dis Obstet Gynecol 13:69–75

    Article  Google Scholar 

  18. 18.

    Martinez RC, Senev SL, Summers KL, Nomizo A, De Martinis EC, Reid G (2009) Effect of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 on the ability of Candida albicans to infect cells and induce inflammation. Microbiol Immunol 53:487–495

    CAS  Article  Google Scholar 

  19. 19.

    Mestecky J, Russell MW (2000) Induction of mucosal immune responses in the human genital tract. FEMS Immunol Medical Microbiol 27:351–355

    CAS  Article  Google Scholar 

  20. 20.

    Witkin SS (2004) Immunological defence mechanisms in the female genital tract. Infectious diseases in obstetrics and gynecology, 5th edn. The Parthenon Publishing Group, Nashville, pp 8–12

    Google Scholar 

  21. 21.

    Wagner RD, Johnson SJ (2012) Probiotic lactobacillus and estrogen effects on vaginal epithelial gene expression responses to Candida albicans. J Biomed Sci 19:58

    Article  Google Scholar 

  22. 22.

    Yang VW, Clausen CA (2005) Determining the suitability of Lactobacilli antifungal metabolites for inhibiting mould growth. World J Microb Biotech 21:977–981

    CAS  Article  Google Scholar 

  23. 23.

    Kaewsrichan J, Peeyananjarassri K, Kougprasertkit J (2006) Selection and identification of anaerobic lactobacilli producing inhibitory components against vaginal pathogens. FEMS Immunol Med Microbiol 48:75–83

    CAS  Article  Google Scholar 

  24. 24.

    Okkers DJ, Dicks LM, Silvester M et al (1999) Characterization of pentocin TV35b, a bacteriocin like peptide isolated from Lactobacillus pentosus with fungistatic effect against C. albicans. J Appl Microbiol 87:726–734

    CAS  Article  Google Scholar 

  25. 25.

    Strus M, Brzychczy-Wloch M, Gosiewski T, Kochan P, Heczko PB (2006) The in vitro effect of hydrogen peroxide on vaginal microbial communities. FEMS Immunol Med Microbiol 48:56–63

    CAS  Article  Google Scholar 

  26. 26.

    Hilton E, Rindos P, Isenberg H (1995) Lactobacillus GG vaginal suppositories and vaginitis. J Clin Microbiol 33:1433

    CAS  Google Scholar 

  27. 27.

    Pirotta M, Gunn J, Chondros P et al (2004) Effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomized controlled trial. BMJ 329:548–552

    Article  Google Scholar 

  28. 28.

    Vicariotto F, Del Piano M, Mogna L, Mogna G (2012) Effectiveness of the association of 2 probiotic strains formulated in a slow release vaginal product, in women affected by vulvovaginal candidiasis: a pilot study. J Clin Gastroenterol 46(Suppl):S73–S80

    Article  Google Scholar 

  29. 29.

    Vacheva-Dobrevski R, Kovachev S, Nacheva A, Stoev S, Vasilev N (2004) Comparative study of itraconazole and fluconazole therapy in vaginal candidosis. Akush Ginekol (Sofiia) 43:20–23

    CAS  Google Scholar 

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Conflict of interest

Stefan Miladinov Kovachev—“Local Probiotic Therapy for Vaginal Candida albicans Infections”. I declare that there is no conflict of interest.

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Correspondence to Stefan Miladinov Kovachev.

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Kovachev, S.M., Vatcheva-Dobrevska, R.S. Local Probiotic Therapy for Vaginal Candida albicans Infections. Probiotics & Antimicro. Prot. 7, 38–44 (2015).

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  • Lactobacilli
  • Vaginal Candida albicans
  • Azoles
  • Probiotic