Case Study #1

Author: Lauren S. Schlesselman, PharmD

BB, a pharmacy student on his ambulatory care rotation, is approached by a medical intern while working in the clinic. The intern explains that he has a patient in a treatment room who has presented him with a problem that he is unsure how to treat.

The patient is a 25-year-old woman who has recurrent vulvovaginal candidiasis. She is not immunocompromised and does not have uncontrolled diabetes mellitus. She had been treating her infections with OTC products until 4 months ago. At that point, she was so frustrated with the monthly infections that she came to the clinic for help. The intern had given her a prescription for 1 dose of oral fluconazole with "asneeded" refills. The patient had used the fluconazole monthly since then, but the infection rate had not decreased. Now the patient would like to find a way to reduce the recurrence of infections.

The intern could not find any information about treatment options that would reduce recurrence. He wanted to find an answer before he approached his attending physician so that he could impress the physician.

What options might BB offer to produce a clinical remission?

Dr. Schlesselman is a clinical pharmacist based in Niantic, Conn.

Click Here For The Answer -----------> [-]

Although they have not been validated with randomized controlled trials, BB can offer some therapies. Treatment should include induction therapy for a minimum of 14 days or until remission is achieved. Standard doses of most OTC and prescription products can be used as induction therapy, so long as they are continued for 2 weeks. Induction should be followed by maintenance therapy for 6 months. Maintenance therapy can include weekly vaginal clotrimazole, weekly fluconazole, daily ketoconazole, or monthly itraconazole.