THE COMPARISON OF EFFICACY BETWEEN DEQUALINIUM CHLORIDE & METRONIDAZOLE + NYSTATIN TOWARDS VULVOVAGINITIS IN PREGNANCY
•Vulvovaginitis is inflammatory & infectious disease of the vulva and vagina. It can cause vaginal discharge, odor, itching, & burning
•Andini RK et al (2019) found that 79.4% vs 20.6% with vs without pathologic fluor albus, consisting of 40-50% BV, 20-25% VVC, & 15-20% trichomoniasis
•There are impacts on mother and fetus
•What is the therapy? Is it empiric therapy or current therapy?
Objective:
To compare the efficacy between dequalinium chloride (DC) & metronidazole + nystatin (MN) as a treatment for vulvovaginitis in pregnancy
Methods:
•RCT, open-label at Dept of Obgyn RSMH Palembang from May 2021 - March 2022.
•83 samples consisting of 13 samples were dropped out and 70 pregnant women with vulvovaginitis & were divided into 2 groups (DC & MN).
•Vaginal swab was examined twice on the 1st day (Gram examination, culture, resistance, colony counting) & 7th day (Gram examination & culture)
Result:
•The majority of samples aged 20–35 years (71.4% & 82.9%, p=0.516) lived in Palembang (57.1% & 51.4%, p=0.810), income below the minimum wage (65.7% & 62.9%, p=1.000), secondary education level (68.6% & 57.2%, p=0.241), normoweight BMI (48.6% & 42.9%, p=0.238), multiparity (37.1% & 45.7%, p=0.328), & 29–42 weeks of gestation (57.14% & 65.7%, p=0.623).
•There were differences in Nugent scores before & after administration of MN (p=0.000) & DC (p=0.000). There was no difference in Nugent score after drug administration between the two groups (p=0.549).
•There were differences in the number of Candida colonies before & after administration of MN (p=0.013) & DC (p=0.008). There was no difference in the number of colonies after drug administration between the two groups (p=0.754).
•There was no difference in recovery between pregnant women with vulvovaginitis who received DC & MN (p=1.000).
Conclusion:
•Most of vulvovaginitis in pregnant women was bacterial vaginosis (Gardnerella vaginalis), candidiasis (Candida albicans), and other bacterial infection (positive Gram bacteria: Staphylococcus hemolyticus and negative Gram bacteria: Escherichia coli).
•Dequalinium chloride & metronidazole + nystatin are equally effective against vulvovaginitis in pregnancy
References:
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•Amabebe E, Anumba DOC. The vaginal microenvironment: The physiologic role of lactobacilli. Front Med. 2018;5:1-11.
•Godha K, Tucker KM, Biehl C, Archer DF, Mirkin S. Human vaginal pH and microbiota: An update. Gynecol Endocrinol. 2018;34(6):451-5.
•Konadu DG, Owusu-Ofori A, Yidana Z, Boadu F, Iddrisu LF, Adu-Gyasi D, et al. Prevalence of vulvovaginal candidiasis, bacterial vaginosis and trichomoniasis in pregnant women attending antenatal clinic in the middle belt of Ghana. BMC Pregnancy Childbirth. 2019;19(1):1-10.
•Waikhom SD, Afeke I, Kwawu GS, Mbroh HK, Osei GY, Louis B, et al. Prevalence of vulvovaginal candidiasis among pregnant women in the Ho municipality, Ghana: Species identification and antifungal susceptibility of Candida isolates. BMC Pregnancy Childbirth. 2020;20(1):1-14.
•Chooprasertsuk W, Somboonporn W, Soontrapa S, Salang LL, Amnatbuddee S. Combined vaginal administration of nystatin, diiodohydroxyquin, and benzalkonium chloride versus oral metronidazole for the treatment of bacterial vaginosis. Int J Gynecol Obstet. 2019;145(3):261-7.
