Antifungal Keeps Yeast Infections at Bay
By Amanda Gardner, HealthDay Reporter
WEDNESDAY, Aug. 25 (HealthDayNews) -- A once-a-week regimen of an antifungal medicine can reduce the rate of recurrent yeast infections in women.
The therapy is far from a cure, but it's better than other treatments for the stubborn problem, researchers say.
"It's a management strategy," said Dr. Jack Sobel, lead author of a study appearing in the Aug. 26 issue of the New England Journal of Medicine and a professor of internal medicine and chief of infectious diseases at Wayne State University School of Medicine.
Thus far, safe and effective long-term treatments for have eluded physicians.
Although not life-threatening, recurrent yeast infections plague about 5 to 8 percent of women during their reproductive years. "It's a very common problem. Nobody dies from this, but it's a source of major physical distress and frustration and it interferes with sex lives," Sobel said. "For many, many years there was no solution other than to treat the patient every time she had a recurrence. That meant she would be running to the doctor every second month. That was a major problem." Also, many existing treatments involved messy and inconvenient vaginal suppositories.
In 1985, according to Sobel, a drug called ketoconazole became available. Daily tablets prevented recurrent infections, but the drug had severe side effects, including jaundice. "Patients were scared to take it and they were right," Sobel said. "I was scared to prescribe it."
This study looked at the antifungal medication fluconazole, a much safer cousin of ketoconazole, which became available in 1991.
Specifically, researchers compared how weekly doses of fluconazole (sold under the brand name Diflucan) compared to a placebo. After clearing up existing yeast infections, 387 women were randomized to receive 150 milligrams of fluconazole or a placebo for six months, followed by six months of observation without therapy. "This was the first large, double-blind multicenter placebo-control study with fluconazole," Sobel said. The study was funded by Pfizer Inc., the maker of Diflucan.
At six months, nine months, and one year, 90.8 percent, 73.2 percent, and 42.9 percent of the women were disease-free, compared with 35.9 percent, 27.8 percent, and 21.9 percent in the placebo group. It took a median of 10.2 months for women in the fluconazole group to develop a recurrence, and only four months in the placebo group.
"We showed very convincingly that taking a tablet once a week can prevent breakthrough infections and gave patients a greater than 90 percent assurance that they would remain attack-free as long as they took the tablet," Sobel said. "You've got tremendous protection as long as you take the drug, but about 40 percent will recur and we don't know how to predict which women will go down this road or that road."
It's not clear what the optimal time for taking fluconazole is, but the fact that the drug did not engender resistance in the fungus is a good sign.
"I've had patients take this for eight or nine years," Sobel said, while emphasizing that this is not scientific data. "I give the patient a choice. If they agree, we put them back on for a year, and at the end of the year we stop, and a similar percentage stays in remission and some promptly recur. There are smaller and smaller numbers who recur, but there is a core of women who are entirely dependent [on fluconazole]."
The only apparent drawback, Sobel said, is the drug's expense: about $10 for one tablet.
"This is a dramatic improvement for quality of life for women, and it is expensive, but it will become less so," he added. "I don't know any other solution. It's simple. It's safe. It's made the infection a nonissue in their lives."
More information
For more information, visit the American Academy of Family Physicians (http://familydoctor.org/ ). 
SOURCES: Jack D. Sobel, M.D., professor of internal medicine and chief, division of infectious diseases, Detroit Medical Center and Wayne State University School of Medicine, Detroit; Aug. 26, 2004 New England Journal of Medicine
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