Optimization of ambulatory treatment of chronic recurrent vulvovaginal candidiasis 
Neufeld I.W., Rogozhina I.E., Skupova I.N.

Saratov State Medical University n.a. V. I. Razumovsky

There is a tendency to an increase in chronic recurrent vulvovaginal candidiasis (CRVVC), caused by Candida fungi virulence and adaptability to antimycotic therapy, and the variety of clinical symptoms, often associated with genital and extragenital diseases.
Objective: Improving the efficiency of the ambulatory treatment of patients with CRVVC by correction of the local immunological disorders.
Patients and methods: The prospective study included 100 women with recurrent VVC. In contrast to the comparison group (n=50) the patients of the control group (n=50) received Galavit® (100 mg) rectally before antifungals according to the scheme: each day during the first 5 days, then 5 doses - every 48 hours and the last 10 doses - every 72 hours; they  also took Itraconazole (200 mg per day for 3 days) beginning with the 15-th dose of Galavit®. Complex clinical, microbiological, and immunological examination was conducted three times: at baseline, after treatment, 6 months after therapy.
Results:  After the treatment the phagocytic, secretory and biocidal functions of neutrophilic granulocytes were normalized in the control group; IL-1β/IFN-γ and IL4/IL4 were 3- and 2.8-times higher than in the comparison group, and  2.8 and 2.9 times higher after 6 months period. After the treatment the clinical and laboratory criteria of cure were achieved 1.2 times more often in the control group, Candida carrier state occurred 2 times less frequently; 6 months later the recurrence rate was 2.1 times lower and Candida carrier state occurred 2.2 times less frequently.
Conclusion: A complex antifungal treatment of CRVVС added with aminodehydroabietic sodium (Galavit®) contributes to normalization of the functional metabolic activity of macrophages and the formation of a full immune response of Th1-type in the cervico-vaginal area, thus significantly improving the results of treatment.

Key words: chronic recurrent vulvovaginal candidiasis, local immunity, immunomodulating therapy, Galavit®, aminodihydrophthalazinedione sodium.
For citation: Neufeld I.W., Rogozhina I.E., Skupova I.N. Optimization of ambulatory treatment of chronic recurrent vulvovaginal candidiasis  // RMJ. 2017. № 2. P. 91–97.