Background: Vaginal candidiasis is a common infection in women. The microflora of the vagina are influenced by a number of factors, including pregnancy, oral contraceptive use, menses and diabetes mellitus. Previous antibiotic use is generally accepted to be a risk factor for vaginal candidiasis but the published evidence to support this is limited.
Aim: To determine the relative risk of vaginal candidiasis following the use of antibiotics compared with antidepressants in prescription-event monitoring (PEM) studies.
Methods: Using data from postmarketing surveillance studies of six antibiotics and six antidepressants, conducted using the observational cohort technique of PEM, the number of reports of vaginal candidiasis was determined in women aged ≥16 years, in each of the first 7 weeks following a prescription for one of these drugs. The relative risks for vaginal candidiasis following the use of these antibiotics and for each of the individual antibiotics compared with antidepressants were calculated for each week and for the overall 7-week period. Women treated with antidepressants were the most suitable comparator group from the PEM database, as they were of a similar age range and the studies were conducted at a similar time period to those of the antibiotics. Also, there was no pharmacological plausibility for vaginal candidiasis being associated with antidepressants.
Results: There were 188 reports of vaginal candidiasis in 31 588 women, aged ≥16 years, treated with antibiotics and 70 in the 45 492 treated with antidepressants. The relative risk for vaginal candidiasis (antibiotic/antidepressants), was highest in the second week, 10.70 (95% CI 4.86–23.55) but was also significantly greater in the first and third weeks after the start of treatment. The risk was also higher in each of the 3 weeks after starting the course for five of the antibiotics, compared individually to the group treated with antidepressants, the exception being fosfomycin, which had a much smaller cohort.
Conclusion: This study shows a significant increase in the risk of developing vaginal candidiasis following the use of the antibiotics studied (ciprofloxacin, ofloxacin, norfloxacin, cefixime, azithromycin and fosfomycin) compared with that after taking the antidepressants fluvoxamine, fluoxetine, paroxetine, sertraline, venlafaxine and nefazodine in these PEM studies.
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Sobel JD. Epidemiology and pathogenesis of recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 1985; 152(7 Pt 2): 924–35
Sobel J. Candidal vulvovaginitis. Clin Obstet Gynecol 1993; 36: 153–65
Galask RP. Vaginal colonization by bacteria and yeast. Am J Obstet Gynecol 1988; 158: 993–5
Khan ZK, Gyanchandani A. Candidiasis: a review. Proc Indian Natl Sci Acad Part B 1998; 64: 1–34
Bluestein D, Rutledge C, Lumsden L. Predicting the occurrence of antibiotic-induced candidal vaginitis (AICV). Fam Pract Res J 1991 Sep; 11(3): 319–26
Spinillo A, Capuzzo E, Acciano S, et al. Effect of antibiotic use on the prevalence of symptomatic vulvovaginal candidiasis. Am J Obstet Gynecol 1999; 180(1 Pt 1): 14–7
MacDonald TM, Beardon PH, McGilchrist MM, et al. The risks of symptomatic vaginal candidiasis after oral antibiotic therapy. Q J Med 1993 Jul; 86(7): 419–24
Iravani A, Bischoff W. Antibiotic therapy for urinary tract infections. Am J Med 1992; 92: 6A–100S
Leigh DA, Joy GE, Tait S, et al. Treatment of acute uncomplicated urinary tract infections with single daily doses of cefuroxime axetil. J Antimicrob Chemother 1989; 23(2): 267–73
Goldstein EJ, Kahn RM, Alpert ML, et al. Ciprofloxacin versus cinoxacin in therapy of urinary tract infections: a randomized, double-blind trial. Am J Med 1987; 82(4A): 284–7
Iravani A, Richard GA. Amoxicillin-clavulanic acid versus cefaclor in the treatment of urinary tract infections and their effects on the urogenital and rectal flora. Antimicrob Agents Chemother 1986; 29(1): 107–11
Mann RD. Prescription-event monitoring: recent progress and future horizons. Br J Clin Pharmacol 1998; 46: 195–201
International ethical guidelines for biomedical research involving human subjects. Geneva: Council for International Organizations of Medical Sciences/World Health Organization, 1993
Guidelines on the practice of ethical committees in medical research involving human subjects. London: Royal College of Physicians of London, 1996 Aug
Kliment M, Korbel M, Hrúzik P, et al. Etiologia patogenéza a diagnostika akútnej a recidivujúcej vulvovaginálnej kandidozy. Praktická gynekológia 1998; 5(1): 1–7
Sobel JD. Recurrent vulvovaginal candidiasis associated with long-term tamoxifen treatment in postmenopausal women. Obstet Gynecol 1996; 88(4 Pt 2): 704–6
Geiger AM, Foxman B. Risk factors for vulvovaginal candidiasis: a case-control study among university students. Epidemiology 1996; 7(2): 182–7
Spinillo A, Capuzzo E, Nicola S, et al. The impact of oral contraception on vulvovaginal candidiasis. Contraception 1995; 51(5): 293–7
Goldacre MJ, Watt B, Loudon N, et al. Vaginal microbial flora in normal young women. BMJ 1979; 1: 1450–3
Clark WJ, Layton D, Wilton LV, et al. Profiles of hepatic and dysrhythmic cardiovascular events following use of fluoroquinolone antibiotics; experience from large cohorts from the drug safety research unit prescription-event monitoring database. Drug Saf 2001; 24(15): 1143–54
McAvoy BR, Kramer EFS. General practice postal surveys: a questionnaire too far? BMJ 1996; 33: 732–3
We would like to record our keen appreciation of the cooperation of the general practitioners and numerous other colleagues who have helped in this investigation. We would particularly like to thank Professor R.D. Mann the previous director of the Drug Safety Research Unit (DSRU) for his initial contribution to this work. In addition we wish to thank Mrs Lesley Flowers for the preparation of this manuscript. We would also like to thank the UK Prescription Pricing Authority for their important participation.
The DSRU is a registered medical charity. It receives unconditional donations from a number of pharmaceutical companies. These companies have no say in the conduct of the studies and have no statistical or editorial control over the analysis or reporting of results. The DSRU has received unconditional donations from some of the manufacturers of these medications but no support was provided for this study. Dr Shakir has received from the pharmaceutical industry lecturing and consultancy fees as well as support to attend scientific meetings unrelated to this study. Dr Wilton has received support from the pharmaceutical industry to attend scientific meetings unrelated to this study.
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Wilton, L.V., Kollarova, M., Heeley, E. et al. Relative Risk of Vaginal Candidiasis After Use of Antibiotics Compared with Antidepressants in Women. Drug-Safety 26, 589–597 (2003). https://doi.org/10.2165/00002018-200326080-00005