Case Study #1
BB, a pharmacy student onhis ambulatory care rotation,is approached by amedical intern whileworking in the clinic.The intern explains thathe has a patient in atreatment room who haspresented him with a problem thathe is unsure how to treat.
The patient is a 25-year-old woman who has recurrent vulvovaginalcandidiasis. She is not immunocompromised anddoes not have uncontrolled diabetes mellitus. She had beentreating her infections with OTC products until 4 months ago.At that point, she was so frustrated with the monthly infectionsthat she came to the clinic for help. The intern had givenher a prescription for 1 dose of oral fluconazole with "asneeded"refills. The patient had used the fluconazole monthlysince then, but the infection rate had not decreased. Nowthe patient would like to find a way to reduce the recurrenceof infections.
The intern could not find any information about treatmentoptions that would reduce recurrence. He wanted to find ananswer before he approached his attending physician so thathe could impress the physician.
What options might BB offer to produce a clinical remission?
Dr. Schlesselman is a clinical pharmacist based in Niantic, Conn.
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Although they have not been validated with randomized controlled trials, BB can offer some therapies. Treatment shouldinclude induction therapy for a minimum of 14 days or until remission is achieved. Standard doses of most OTC and prescription productscan be used as induction therapy, so long as they are continued for 2 weeks. Induction should be followed by maintenance therapy for 6months. Maintenance therapy can include weekly vaginal clotrimazole, weekly fluconazole, daily ketoconazole, or monthly itraconazole.