Limitations of antifungal agents in the treatment of Candida vaginitis: future challenges.

The availability of several potent antifungal agents, systemic or topical, over the counter or prescription would suggest that therapeutic needs for Candida vaginitis are minimal or absent. Unfortunately, unmet needs still exist. Moreover, the pharmaceutical industry has abandoned Candida vaginitis and no new agents or studies are imminent. Perhaps the most important advance in the last decade has been the recognition that therapy must be individualized and that not all forms of Candida vaginitis are equal. A critical factor is duration of therapy and the need for maintenance therapy in recurrent candidiasis. In addition, serious deficiencies exist in the therapy of C. glabrata vaginitis, an emerging problem. Azole therapy for C. glabrata frequently fails, depleting the therapeutic armamentarium of successful options. Additional therapeutic challenges remain for women who can be easily controlled but not cured with intensive azole therapy in spite of absence of in vitro antifungal resistance. Any advance in non-drug related therapy will require a better understanding of the immunopathogenesis of VVC and effective naturally occurring host protective mechanisms. Copyright 1999 Harcourt Publishers Ltd.