ANTI-CANDIDA DRUGS: MERITS AND DEMERITS

A PROJECT REPORT SUBMITTED TO RAJIV GANDHI INSTITUTE OF I.T & B.T, BHARATI VIDYAPEETH DEEMED UNIVERSITY, KATRAJ, PUNE FOR THE PARTIAL FULFILLMENT OF DEGREE OF MASTERS OF SCIENCE IN BIOTECHNOLOGY (2012 2013)

SUBMITTED BY Delfi Omid Khetarpal Priya Mishra Neelam Pulwale Anubha Singh Pooja

UNDER THE GUIDANCE OF:

MICROBIOLOGY DEPARTMENT, RAJIV GANDHI INSTITUTE OF I.T & B.T BHARATI VIDYAPEETH DEEMED UNIVERSITY PUNE 411043

DR. BIPINRAJ N.K., ASSISTANT PROFESSOR

ACKNOWLEDGEMENT:

We express our sincere gratitude to Dr. G.D Sharma, Principal and Dr. S A Shaikh, Vice-Principal of BVDU Rajiv Gandhi Institute of IT and BT, Pune for giving us permission to carry out our group project successfully. We sincerely express our deep sense of gratitude and immense respect to our guide Dr. Bipinraj N. K., for his scholarly guidance, generous encouragement and suggestion throughout the course of our project work. We express our sincere thanks to the doctors whom we consulted for giving us their valuable time and sharing their experience with the patients. We express our sincere thanks to the chemist we visited for giving us their valuable time imparting us the necessary information regarding the name of various medicines and their sales. We also express our sincere thanks to the students for co-operating and helping us. At last we express our special thanks to all our friends for their affectionate cooperation work without which would have not been possible.
Delfi Omid, Khetarpal Priya, Mishra Neelam, Pulwale Anubha and Singh Pooja

INDEX
Sr.No. 1 Title Page. No. 1-8

INTRODUCTION:

Candidiasis. Diseases due to Candida Vulvo-vaginal candidiasis Classification of vvc Susceptible patients. Treatment Probiotic
8 9-11

Aim Methodology
Questionnaire format
For women For gynaecologist For chemist.

Observation :

12-17

Different medicines available.

o o Candida Fluconazole

Recurrent vulvovaginal candidiasis Probiotics

18 19 20

Result Conclusion References

5
6

Anti- candida drugs

1. INTRODUCTION 1.1 Candidiasis
The term candidiasis is used to refer to the diseases caused by fungi of the genus Candida. A common saprophyte in the human gastrointestinal tract and elsewhere. Until recently, Candida infection was thought to be caused by Candida albicans, however, in the last few years other Candida species, such as C. parapsilosis, C. tropicalis and C. krusei, have been found to be important causes of disease. Candida species, particularly C. albicans, colonize the human gastrointestinal, respiratory and reproductive tracts, skin, and nails of most healthy people.

1.2 Susceptible host to candidal infection:

1.2.1 Women. Women are far more affected than men, perhaps because women have a slower oxidation rate, in general, and this may play a role as well. Also, women use birth control pills and copper IUDs that may upset copper metabolism and cause other problems that may contribute to the problem. 1.2.2.Vegetarians : This may be because vegeterians are almost all low in zinc, which is found almost exclusively in meats & eggs. As a result , they accumulate more copper in their bodies. Also vegeterians protein foods such as nuts, seeds & beans are higher in copper & lower in zinc .Also , vegetarian diets are much more expanded than diets with more meat. 1.2.3.Babies : Some babies have yeast problems because fed sweets, mainly milk has some sugars in it but this alone is not usually the cause.Newborns sometimes get thrush or cotton mouth. This affects the mouth that is often due to feeding children or babies fruit juices for example, or pasteurized milk rather than mothers milk. 1.2.4.Anyone who eats sugar at all, or any fruit or sweet juices of any kind. 1.2.5. Copper Imbalance : If the copper imbalance is much worse & often will not go away until copper metabolism is corrected with a nutritional balancing program. Copper is one of the bodys natural yeast fighters. In fact copper compounds are used
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on crops such as CUSO4, & in swimming pools & hot tubs at times to control yeast & fungal growth. 1.3 Common diseases due to candida: Candida can cause different forms of human diseases. The important ones are give below. 1.3.1 Allergy: Candida species can cause allergic rhinitis, sinusitis, asthma, combined allergic rhinitis asthma syndrome (CARAS), hypersensitivity pneumonitis, allergic broncho-pulmonary candidiasis urticaria or urticaria angioedema syndrome, and atopic eczema. Urticaria is the most common form of Candida allergy. 1.3.2. Oral Candidasis: It includes thrush, glossitis, stomatitis, and angular cheilitis. 1.3.3. Mucocutaneous Candidiasis : Patients have persistent and/or recurrent candidiasis of the skin, nails, and mucous membranes. 1.3.4. Onycomycosis : Parnoychia is related to finger nails. The candiasis lesion are painful erythematous swelling around the affected nail. 1.3.5. Oesophageal Candidiasis : It is frequently associated with AIDS or immunosuppresion followed by cytostatics and oral candidiasis. Symptoms are a burning pain on the retroesternal area, dysphagia, nausea and vomiting. 1.3.6 Gastrointestinal Candidiasis : It can be associated with hematological malignancies, often presenting as ulcerations of the stomach, and less frequently of the duodenum and intestine leading to peritonitis and disseminated candidiasis. 1.3.7. Hepatic &Hepattosplenic Candidiasis : It occurs mainly in immunocompromised patients or those with severe neutropenia, usually acute leukemias. Clinical diagnosis is usually fever, hepatosplenomegaly and increased blood alkaline phophatase. 1.3.8 Candidial infection of the gallbladder, pancreas & peritoneum : It is rare but can

create additional complications in immunocompromised patients. The symptoms are fever, abdominal pain, tenderness, and a cloudy peritoneal dialysate leukocyte count. 1.3.9. Candidial Endocarditis , Mycocarditis & Pericarditis : Endocarditis is the most common form of cardiac candidiasis. Clinical symptoms include fever, cardiac murmurs, congestive heart failure, anemia, and splenomegaly. 1.3.10 Candidal supurative phlebitis : It can occur in immunocompromised patients. 1.3.11 Vulvo vaginal candidiasis : a common l vaginal infection found in women. As Vulvovaginal Candidiasis is the most common candidal infection observed (ref) and reports on the side effects of the drugs (ref) the study is emphasized on VVC. with high

1.4 Vulvovaginal Candidiasis:

Vulvovaginal candidiasis (VVC) is a vaginal infection caused by Candida albicans and other fungal species. VVC accounts for about 1/3rd of the vaginitis cases. Some health practitioners have estimated that 75% of adult women suffer at least one episode of vulvovaginal candidiasis during their lifetime. Yeast is carried in the vagina in small numbers and as they produce no symptoms they may be considered as a part of the normal vaginal flora. Volvovaginal candidiasis may result if conditions in the vaginal change so as to give the yeast an advantage in competing over the normal vaginal bacteria and inflammatory response. Inhibition of normal bacterial flora by broad spectrum antibiotics favors the growth of yeast. In the recent years, the increasing incidence of HIV infection and of the advanced therapeutic modalities for life support, surgical procedures like organ transplant and the implantation of prosthetic devices have been important in the expanding incidence of candidal infections.

1.4.1 Symptoms: 1. Intense vulvas pruritus 2. Burning erythema 3.Dysparevnia associated with a creamy white curd like discharge. 1.4.2 Classification of vulvovaginal candiasis: Two types of classification. : On the basis of infection. Etiological classification.
1.4.2.1 On the basis of infection: They are divided in two categories complicated and

uncomplicated.
1.4.2.1.1 Complicated : Complicated vulvovaginal candidiasis is associated in most

cases with candidiasis at other locations including mouth, skin, or nails.The complicated form of vulvovaginitis is seen in the remaining 10% of patients,generally as recurrent bouts of infection after local and systemic treatment According to a research, 46 out of 57 (80%) females with mucocutaneous candidiasis patients presented complicated vulvovaginitis.
1.4.2.1.2.Uncomplicated: The severity of infection is mild to moderate. The infecting

organism is C.albicans . Uncomplicated vaginitis is seen in 90% of patients & usually responds readily to short course oral or tropical treatment. 1.4.2.2 Etilogical classification of vulvovaginal candidiasis Three broad categories are there: Primary candidiasis Antibiotic induced candidiasis. Systematically induced candidiasis .

1.5 Treatment for candidiasis:

Vaginal candidiasis is treated with antifungal medications. Several are available in the form of creams, suppositories and tablets that can be placed directly in the vagina. These drugs are commonly known as anticandida drug. 1.5.1 Anti-candida drugs: They belong to the N-subsituted imidazoles and tiozoles, some are also allylamines.They are classified by their site of action in the fungal cell. The polyene antifungal agents, which include nystatin and amphotericin B, are fungicidal and have the broadest spectrum of antifungal activity of the available agents. The polyenes kill the fungal cell by intercalating into ergosterol containing membranes to form channels and destroy the proton gradient in the cell due to leakage of cytoplasmic content . The azoles comprise the second class of antifungal agents and include the imidazoles (clotrimazole, miconazole and ketoconazole) and the triazoles (fluconazole and itraconazole). The azoles inhibit ergosterol biosynthesis through their interactions with the enzyme lanosterol demethylase, which is responsible for the conversion of lanosterol to ergosterol, leading to the depletion of ergosterol in the membrane. Fluconazole is the most effective agent for the treatment of pharyngeal and vaginal candidiasis. On the basis of pharmacological origin, distinguish the following groups as antimycotics:

Drugs from the group of antibiotics: nistatit, pimafutsin, levorin Preparations of a group of imidazolines: ketoconazole, clotrimazole, miconazole Drugs from the group triazolinov: itraconazole, fluconazole Combination drugs: mikozhinaks, pimafukort

1.5.2 Probiotics

Several studies conducted world-wide have proven that consumption of probiotic yogurt reduced the incidence of VVC in patients. Probiotic organisms are live microorganisms that are thought to be beneficial to the host organism. According to the currently adopted definition by, probiotics are "Live microorganisms which when administered in adequate amounts conferring a health benefit on the host".

Probiotics are commonly consumed as part of fermented foods with specially added active live cultures, such as in yogurt, soy yogurt or as dietary supplements.

Live probiotic cultures are available in fermented dairy products and probiotic fortified foods. However, tablets, capsules, powders and sachets containing the bacteria in freeze dried form are also available. Although benefits are well documented use of probiotics as an anticandidal agents are not practiced. The reason may be lack of awareness of the benefits of probiotics among the practitioners or the chemists or the patients.

2. Aim of Our Study:

1. To find out the use, merits and demerits of various anti-candidal drugs. 2. To find out use of probiotics as anticandidal agents. 3. Spread the benefits of probiotics.

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3. Methodology:
Three stakeholders selected for the study are; Chemist. Women of different age group. Gynaecologist. 3.1 Questionnaire for chemist:

Third part of the survey was conducted with chemist of different areas. They were asked questions on drugs used for the treatment of candidiasis, age of the consumer, month in which the sale is maximum and drug with maximum sale. They were also asked about probiotics. By this survey we wanted to know about the various medicines which are available in market and their sale as it would help to know the most used drug. The format of questionnaire is as follows:

PROJECT- WORK CHEMIST

NAME OF THE SHOP: LOCATION OF THE SHOP: NAME OF THE ANTICANDIDA DRUGS AVAILABLE: MOST PURCHASED ANTICANDIDA DRUG: AGE OF THE PATIENT: FREQUENCY OF THE MEDICINE: SR. NO. 1. 2. 3. 11 DRUGS JUNE SEPTEMBER - OCTOBERJANUARY FEBRUARY MAY -

4. DO THEY ASK FOR ANY PROBIOTICS? IS THERE ANY PRESCRIPTION FOR PROBIOTICS? LIST OF PROBIOTICS AVAILABLE: SR. NO. 1. 2. 3. 4. WHAT ARE THE OTHER DRUGS IN THE PRESCRIPTION? PROBIOTICS DISEASE PRICE

3.2 Questionnaire for women: Questionnaire was designed in a way to find out (i) regular diet with an aim to know is there any probiotic involved in their diet, (ii) history of diseases they suffered in past one year, with an aim to find out the general health of the candidate and (iii) awareness and use of probiotics. This survey was conducted on hundred women covering college students, working women and housewives of age group 20-40. The format of the questionnaire is as follows:

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3.3 Questionnaire for gynaecologist: Second part of the survey focused on gynaecologist from different hospitals. It was focused on their experiences with vvc patients, age group of the patients, medicines they prescribed and whether they prescribe any probiotics to the patients. The aim was to find out the (i) frequency of patients with VVC, (ii) complications associated with treatment during pregnancy and (iii) various drugs used for the treatment. The format of questionnaire which was used for gynaecologist is as follows:

PROJECT- WORK GYNAECOLOGIST

NAME OF THE DOCTOR: NAME OF THE HOSPITAL : FREQUENCY OF THE PATIENT WITH VVC: AGE GROUP OF THE PATIENTS WITH VVC: ANY SPECIFIC SEASON/ WEATHER: MEDICINE PRESCRIBED TO THE PATIENT: DRUGS FOR RECURRING VVC: ANY PROBIOTICS PRESCRIBED TO THE PATIENT: DO YOU PRESCRIBE FOR ANY SPECIFIC DIET DURING THE INFECTION?

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4. Observation:
From the survey conducted with different groups following results were obtained: 4.1 women of different age group: Total 100 women of age group 20-40 were included in the survey and the observations were as follows: 1. 4.2 Chemist: Survey covered 20 chemists from Katraj and Swargate region. The survey showed total 20 anticandidal drugs are there in the market. The price of the drug varied Rs. 12 to 180. The list of anti-candidal drugs are given in table 1. Sr. No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Azee. Azithral - 500 Candid. Canstin Cloban G Dk. Gel Eumosome Eumosome m Flucanazole. Forcan-150 Fucis-150 Nulforce - 150 Nystatin Sanbetnm Seabax lotion Secnidazole. Secniforte Terbicip-250 Anti- candidal Drugs. Rs. 71.0 Rs. 150.0 Rs. 75.0 Rs. 87.0 Rs. 62.0 Rs. 42.0 Rs. 56.20 Rs. 46.20 Rs. 33.00 Rs. 150.00 Rs. 12.0 Rs. 89.0 Rs. 180.0 Rs. 34.0 Rs. 43.0 Rs. 68.0 Rs. 37.85 Rs. 12.86 Throughout the year. Throughout the year. Throughout the year June September. June September. June September. June September. June September. Throughout the year. June - September. June- September Throughout the year. June September. June September. June September. Throughout the year Throughout the year. June - September.
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Price

Maxium sale

Major anticandidal compound

19 20

Terbinafine Zocan-150

Rs. 70.0 Rs. 33.0

June September. Throughout the year.

The interaction with the chemist revealed that people with age group between 20-40 are the major customers for the anticandidal drug. Most of the medicine are available And used throughout the year but their sale is maximum during rainy season. Flucanazole and Candidare the most prescribed as well as preferred medicine indicating their well acceptance. After checking the chemical composition of each medicine it was observed that Clotrimazole is the basic component of most of the anti-fungal drugs.

4.1 Candid:
Candid cream and tablets are an anti fungus medicine used to treat a vaginal infection such as thrush which is a yeast infection. 4.1.1 Composition: Clotrimazole In water miscible base

4.1.2 Mode or Mechanism of Action: Clotrimazole has broad spectrum fungicidal activity against Dermatophytes (Trichophyton, Epidermophyton and Microsporum spp.), Candida and Aspergillus spp., Malassezia furfur and other fungi. It also inhibits some strains of Gram-positive and Gram-negative bacteria. 4.1.3Pharmacology: Clotrimazole is an imidazole antifungal agent and is effective against a wide variety of fungi including Epidermophyton, Microsporum and Trichophyton spp., Coccidioides immitis, Histoplasma capsulatum, Aspergillus and Candida spp. Other fungi responding
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to Clotrimazole include Cryptococcus neoformans, Malassezia furfur (Pityrosporum orbiculare), Paracoccidioides brasilliensis, Sporothrix schenckii, Pseudallescheria, Medurella and Phialophora spp. Clotrimazole also has antibacterial action and some strains of Staphylococcus aureus and Streptococcus pyogenes have been reported to be sensitive. Clotrimazole is believed to exert its activity on the cell membrane of the fungus. It appears that the drug inhibits protein synthesis and so influences the utilisation and the incorporation of the acylated amino acids essential for fungi. 4.1.4Contraindications: Except for possible hypersensitivity reactions, there are no contraindications. 4.1.5SideEffects: The local tolerance of CANDID Cream is excellent and no systemic effects are seen with topical use. Rarely patients experienced local irritation. This generally disappeared on continuing the therapy. 4.1.6 Recommended Dosage, Dosage Schedule and Route of Administration: The affected area should be washed and thoroughly dried. CANDID Cream is evenly rubbed into the affected area 2-3 times daily. Treatment should continue for 2-4 weeks after the disappearance of all signs of infection to ensure mycological cure and prevent relapse.

4.2 Fluconazole:
Fluconazole is an antifungal drug which is easily available in the form of tablets. It is a synthetic triazole.

4.2.1Compositions:
Colloidal silicon dioxide. Fluconazole: 200 mg.
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Corn starch croscarmellose sodium.. Lactose monohydrate. Magnesium stearate. Microcrystalline cellulose.

4.2.2Mechanism of action:
Fluconazole is a highly selective inhibitor of fungal cytochrome P450 dependent enzyme lanosterol, 14-a-demethylase. This enzyme functions to convert lanosterol to ergosterol. The subsequent loss of normal sterols correlates with the accumulation of 14-amethyl sterols in fungi and may be responsible for the fungistatic activity of fluconazole. Mammalian cell demethylation is much less sensitive to fluconazole inhibition.

4.2.3Activity in vitro and in clinical infections:

Fluconazole has been shown to be an active against most strains of the microorganism both in vitro and in clinical infection. Some of the microorganisms are Candida albicans, Candida glabrata, Candida parapsilosis, Candida neoformans, Candida tropicalis There have been reports of cases of super infection with Candida sp other than C. albicans.which are often inherently not susceptible to fluconazole. Such cases may require alternative antifungal therapy.

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4.2.4Activity in vivo:
In common with other azole antifungal agents, most fungi show a higher apparent sensitivity to fluconazole in vivo than in vitro. Fluconazole administered orally or intravenously was active in a variety of animal models of fungal infection using standard laboratory strain of fungi. Activity has been candidiasis. observed in vaginal

4.2.5 Dosage: Most women only need one dose, although women with more complicated infections (such as those with underlying medical problems, recurrent yeast infections, or severe signs and symptoms) may require a second dose 72 hours (3 days) after the first dose.

4.2.6 Side effects: Side effects of fluconazole are mild and infrequent, but may include stomach upset, headache, and rash. Fluconazole interacts with a number of medications; ask your doctor, nurse, or pharmacist if you have concerns. Fluconazole is not usually recommended during the first trimester of pregnancy due to the potential risk of harm to the foetus.

4.

RECURRENT VULVOVAGINAL CANDIDIASIS:

Vulvovaginal candidiasis is considered recurrent when at least four specific episodes occur in one year or at least three episodes unrelated to antibiotic therapy occur within one year. Although greater than 50 percent of women more than 25 years of age develop vulvovaginal candidiasis at some time, fewer than 5 percent of these women experience recurrences. Clinical evaluation of recurrent episodes is essential.

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Known etiologies of recurrent vulvovaginal candidiasis include treatment-resistant Candida species other than Candida albicans, frequent antibiotic therapy and contraceptive use, compromise of the immune system, sexual activity and hyperglycemia. Although Candida albicans is the pathogen identified in most patients with vulvovaginal candidiasis, other possible pathogens include Candida tropicalis and Candida glabrata. than C. albicans, which are often inherently not susceptible to fluconazole. Such cases may require alternative antifungal therapy.

5.1 Causes of Recurrence:

Although Candida albicans is the pathogen identified in most patients with vulvovaginal candidiasis, other possible pathogens include Candida tropicalis and Candida glabrata. Increasingly, Candida species other than C. albicans have been found to cause yeast vaginitis (i.e., 9.9 percent of cases in 1988 and 17.2 percent of cases in 1995).In fact, recurrent infections may be caused by the resistance of non C. albicans species to antifungal agents. In vitro studies have shown that imidazole antifungal agents such as miconazole and clotrimazole are not as effective against non C. albicans fungi. C. tropicalis and C. glabrata are 10 times less sensitive to miconazole than is C. albicans. Imidazoles are still the first-line treatment for C. albicans infections. A 1993 in vitro study examined more than 250 strains of C. albicans and found that no strain was resistant to ketoconazole, itraconazole and clotrimazole. Although antifungal resistance can cause treatment failure, other factors may contribute to recurrent vulvovaginal candidiasis Noncompliance with a treatment regimen may result in persistent infection that is mislabeled as a recurrence. For example, a patient may not complete the entire course of antifungal therapy, especially if an inconvenient topical treatment has been prescribed. A recurrence may also represent an inadequately treated infection. Between 15 and 20 percent of women with negative cultures after treatment have positive cultures within three months. If an infection recurs at least three months after the previous episode, it is more likely to be caused by a different C. albicans strain.
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5.2 Causes:
Antibiotics are often implicated as a cause of recurrent vulvovaginal candidiasis. Frequent antibiotic use decreases protective vaginal flora and allows colonization by Candida species.The risk of a yeast infection increases with the duration of antibiotic use, but no specific antibiotic has been shown to be more likely to cause yeast infections. Diabetes mellitus is often considered a predisposing factor for recurrent vulvovaginal candidiasis. Hyperglycemia enhances the ability of C. albicans to bind to vaginal epithelial cells. However, unless other symptoms are suggestive of diabetes, patients with recurrent vulvovaginal candidiasis are rarely found to be diabetic. Contraceptive methods may also promote recurrences of vulvovaginal candidiasis. Use of spermicidal jellies and creams increases susceptibility to infection by altering the vaginal flora and increasing the adhesion of Candida organisms. Women who take oral contraceptive pills have a higher rate of vulvovaginal candidiasis. According to one theory, Candida cells have estrogen and progesterone receptors that, when stimulated, increase fungal proliferation. Women who are prone to recurrent vulvovaginal candidiasis may have deficient cellmediated immunity. Similarly, persons with acquired immunodeficiency syndrome are susceptible to systemic candidal infection. Some studies suggest that 40 to 70 percent of women with recurrent vulvovaginal candidiasis have some specific energy resulting in a subnormal T-lymphocyte response to Candida. One study found that Lewis A and B blood group antigens on the vaginal epithelium are protective against candidal infection. Mechanical factors may also be important. Perspiration associated with tightly fitted clothes or poorly ventilated underwear increases local temperature and moisture. Mechanical irritation of the vulvovaginal area by clothing or with sexual intercourse may also predispose already colonized areas to infection. One study demonstrated a positive relationship between the monthly frequency of sexual intercourse and the incidence of recurrent vulvovaginal candidiasis
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5.3 Treatment:

The optimal treatment for recurrent vulvovaginal candidiasis has not yet been defined. Consequently, treatment must be individualized based on a comparison of effectiveness, convenience, potential side effects and cost. If a patient has infrequent recurrences, the simplest and most cost-effective regimen involves self-diagnosis and the early initiation of topical therapy. A monthly 150-mg dose of orally administered fluconazole has been shown to reduce the incidence of recurrences by 50 percent.Itraconazole, in a dosage of 200 mg or 400 mg administered orally once a month also has been found to decrease the recurrence rate by approximately 50 percent. Boric acid administered in a 600-mg vaginal suppository twice daily for two weeks and then daily during menstruation, has been effective in the treatment of women with resistant infection. However, the use of boric acid is limited by significant local irritation and the possibility of intoxication.

6. Alternative to Anti- Candida Drugs:

There are many alternatives to anticandida drugs like probiotics and natural remedies. Here we are focusing on probiotics which is an excellent option for the treatment of candidiasis.

6.1Probiotics:

Table list of probiotics available in the market and their composition.

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6.2Types:
Live probiotic cultures are available in fermented dairy products and probiotic fortified foods. However, tablets, capsules, powders and sachets containing the bacteria in freeze dried form are also available. The following probiotic strains are useful: 6.2.1Bifidobacterium - Includes bifidum and longum strains used to control mineral absorption and regulation of other bacteria. 6.2.2Enterococcus faecium - May affect cholesterol levels and may help relieve symptoms associated with antibiotic diarrhea.
6.2.3Lactobacillus - Includes acidophilus, bulgaricus, and rhamnosus strains and is the

most common type of probiotic. 6.2.4Streptococcus thermophilus - Helps digest lactose and may aid people with lactose intolerance. Some fermented products containing similar lactic acid bacteria include:

Pickled vegetables, Fermented bean paste such as tempeh, miso and doenjang Kefir Buttermilk or Karnemelk Kimchi Pao cai Sauerkraut Soy sauce
Zha cai

7.3Probiotics for vvc:

Probiotics have been investigated as possible agents for the prevention of VVC.

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In some studies the development of VVC was associated with either a low number of lactobacilli in the vagina or with the presence of H2O2-non-producing vaginal lactobacilli, although there are a few studies not supporting these statements. In addition, in vitro studies have shown that lactobacilli can inhibit the growth of Candida albicans and/or its adherence on the vaginal epithelium. The results of some clinical trials support the effectiveness of lactobacilli, especially Lactobacillus acidophilus, Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14, administered either orally or intravaginally in colonizing the vagina and/or preventing the colonization and infection of the vagina by C. albicans, while the results of a small number of clinical trials do not corroborate these findings. Nevertheless, most of the relevant clinical trials had methodological problems such as small sample size, no control group (placebo) and included women without confirmed recurrent VVC, and thus they are not reliable for drawing definitive conclusions. Thus, the available evidence for the use of probiotics for prevention of recurrent VVC is limited. However, the empirical use of probiotics may be considered in women with frequent recurrence of VVC (more than three episodes per year), especially for those who have adverse effects from or contraindications for the use of antifungal agents, since adverse effects of probiotics are very rare. In conclusion, despite the promising results of some studies, further research is needed to prove the effectiveness of probiotics in preventing the ocurrences of VVC and to allow their wide use for this indication.

8. Results:

Survey with different groups showed following results:

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Survey with women showed that only 8 out of 100 had vvc in past one year. The age group mainly suffering from vvc is from 21 to 30 years and it occurs throughout the year.

Survey with chemist helped us in knowing about the medicines. Flucanozole and candida were the most common drugs. Patients who asked for anticandida drugs , also asked for probiotics.

Meeting with gynaecologist proved to be very helpful. More than 50 patients in a month were diagnosed with vvc and the age group is 20-40.

Any kind of demerits from anticandida drugs could not be found. Most of the people are not aware of probiotics. Even though probiotics are available in the market, we could not be sure whether they are prescribed with anti candida drugs or with any other disease.

Gynaecologists do not prescribe for any probiotics. Most of them did not know about probiotics.

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9. CONCLUSION:
From the survey conducted on three different stakeholders it was revealed that many drugs for candidal infection are available thoughtout the year indicating the wide spread of various candidal infection.The two mostly used drugs prescribed for the infection are flucanozole and candid. Clotrimazole is the most used component in all the anti-candida drugs. Although there are reports on several side effects of these drugs, as people are not open to talk about vaginal infection, the demerits of the drugs could not be found. Interaction with gynaecologists indicated that VVC and recurring VVC infection is common in pregnant women in ---------- trimester. The drugs prescribed are common for non-pregnant and pregnant women. This may be due to the lack of awareness of the demerits or availability of a safe method of treatment. It was also found that avoiding food with high content of starch and sugar will reduce the frequency and severity of infection. Although many probiotics are available in the market most of the medical practitioners were not aware of the benefits of probiotics. -----------------------------------------------------------------------------------------------------------------------------------------. Even if they are used, they are used for some other ailment such as diarrhoea. The lack of basic information of benefits of probiotics among the doctors are the major hurdle in the wide use of various probiotics.

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Moreover, in general microorganism are considered as harmful and this misconception need to be cleared for a healthy society.

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10. References :

www.localhealth.com www.ncbi.nlm.nih.gov/pubmed/3319421 Research papers: Candidiasis Carlos. Candida albicans : genetics, dimorphism and by A.G. Palma-Carlos/ M. Laura Palma-

pathogenicity.
o o o

By: Gloria Molero Gloria Molero Rosala Dez-Orejas

Federico Navarro-Garca Luca Monteoliva Jess Pla Concha Gil Miguel Snchez-Prez Csar Nombela

Interaction with the chemist and gynaecologist and survey reports.

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